|
HC ESOPHAGOSCOPY W BLLN LT 30MM
|
Facility
|
IP
|
$4,574.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
900501292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$4,116.60 |
| Rate for Payer: Adventist Health Commercial |
$914.80
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,201.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,904.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,698.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
|
HC ESOPHAGOSCOPY W BLLN LT 30MM
|
Facility
|
OP
|
$4,574.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
900501292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$914.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Cigna of CA HMO |
$2,927.36
|
| Rate for Payer: Cigna of CA PPO |
$3,384.76
|
| 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 |
$3,201.80
|
| 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 |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| 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 |
$2,904.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,653.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,744.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,287.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,287.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,287.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,287.00
|
| 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 ESOPHAGOSCOPY W OPTICAL ENDOMI
|
Facility
|
IP
|
$3,053.00
|
|
|
Service Code
|
CPT 43206
|
| Hospital Charge Code |
906743206
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$2,747.70 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,442.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,747.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,938.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,801.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.60
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: Networks By Design Commercial |
$1,984.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
|
|
HC ESOPHAGOSCOPY W OPTICAL ENDOMI
|
Facility
|
OP
|
$3,053.00
|
|
|
Service Code
|
CPT 43206
|
| Hospital Charge Code |
906743206
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Adventist Health Commercial |
$408.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,632.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,442.40
|
| Rate for Payer: Cigna of CA HMO |
$1,953.92
|
| Rate for Payer: Cigna of CA HMO |
$1,306.24
|
| Rate for Payer: Cigna of CA PPO |
$2,259.22
|
| Rate for Payer: Cigna of CA PPO |
$1,510.34
|
| 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 |
$2,137.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,428.70
|
| 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 |
$2,595.05
|
| Rate for Payer: Galaxy Health WC |
$1,734.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,224.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,836.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,747.70
|
| 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) 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 |
$1,938.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,296.04
|
| 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 |
$408.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$1,530.75
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: Networks By Design Commercial |
$1,984.45
|
| Rate for Payer: Networks By Design Commercial |
$1,326.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,734.85
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,224.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,831.80
|
| 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 |
$1,526.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,020.50
|
| 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 ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
IP
|
$4,594.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$918.80 |
| Max. Negotiated Rate |
$4,134.60 |
| Rate for Payer: Adventist Health Commercial |
$918.80
|
| Rate for Payer: Cash Price |
$2,067.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,675.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,215.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,837.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,837.60
|
| Rate for Payer: Galaxy Health WC |
$3,904.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,756.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,134.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,917.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,710.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.80
|
| Rate for Payer: Multiplan Commercial |
$3,445.50
|
| Rate for Payer: Networks By Design Commercial |
$2,986.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,904.90
|
|
|
HC ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
OP
|
$4,594.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$290.08 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$918.80
|
| Rate for Payer: Adventist Health Commercial |
$614.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,067.30
|
| Rate for Payer: Cash Price |
$2,067.30
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cash Price |
$2,067.30
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,456.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,675.20
|
| Rate for Payer: Cigna of CA HMO |
$1,964.80
|
| Rate for Payer: Cigna of CA HMO |
$2,940.16
|
| Rate for Payer: Cigna of CA PPO |
$3,399.56
|
| Rate for Payer: Cigna of CA PPO |
$2,271.80
|
| 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 |
$2,149.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,215.80
|
| 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 |
$3,904.90
|
| 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 |
$2,756.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,763.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,134.60
|
| 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 |
$290.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$290.08
|
| 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 |
$1,949.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,917.19
|
| 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 |
$918.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,445.50
|
| Rate for Payer: Multiplan Commercial |
$2,302.50
|
| Rate for Payer: Networks By Design Commercial |
$2,986.10
|
| Rate for Payer: Networks By Design Commercial |
$1,995.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,609.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,904.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,842.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,756.40
|
| 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 |
$2,297.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,535.00
|
| 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 ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
OP
|
$4,594.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$918.80
|
| Rate for Payer: Adventist Health Commercial |
$614.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cash Price |
$2,067.30
|
| Rate for Payer: Cash Price |
$2,067.30
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cash Price |
$2,067.30
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cash Price |
$2,067.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,675.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,456.00
|
| Rate for Payer: Cigna of CA HMO |
$1,964.80
|
| Rate for Payer: Cigna of CA HMO |
$2,940.16
|
| Rate for Payer: Cigna of CA PPO |
$3,399.56
|
| Rate for Payer: Cigna of CA PPO |
$2,271.80
|
| 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 |
$3,215.80
|
| 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 |
$2,609.50
|
| Rate for Payer: Galaxy Health WC |
$3,904.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,842.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,756.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,134.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,763.00
|
| 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) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| 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 |
$1,949.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,917.19
|
| 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 |
$1,254.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,302.50
|
| Rate for Payer: Multiplan Commercial |
$3,445.50
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$1,995.50
|
| Rate for Payer: Networks By Design Commercial |
$2,986.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,904.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,609.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,756.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,842.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,535.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,535.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,535.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,297.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,297.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,535.00
|
| 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 ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
IP
|
$4,594.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$918.80 |
| Max. Negotiated Rate |
$4,134.60 |
| Rate for Payer: Adventist Health Commercial |
$918.80
|
| Rate for Payer: Cash Price |
$2,067.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,675.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,215.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,837.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,837.60
|
| Rate for Payer: Galaxy Health WC |
$3,904.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,756.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,134.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,917.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,710.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.80
|
| Rate for Payer: Multiplan Commercial |
$3,445.50
|
| Rate for Payer: Networks By Design Commercial |
$2,986.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,904.90
|
|
|
HC ESOPHAGUS CELLVIZIO
|
Facility
|
OP
|
$7,408.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,166.53 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,481.60
|
| Rate for Payer: Adventist Health Commercial |
$785.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$1,900.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,586.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,309.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,283.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,333.60
|
| 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 |
$3,333.60
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,140.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,926.40
|
| Rate for Payer: Cigna of CA HMO |
$2,512.00
|
| Rate for Payer: Cigna of CA HMO |
$4,741.12
|
| Rate for Payer: Cigna of CA PPO |
$2,904.50
|
| Rate for Payer: Cigna of CA PPO |
$5,481.92
|
| 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 |
$5,185.60
|
| 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 |
$3,336.25
|
| Rate for Payer: Galaxy Health WC |
$6,296.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,355.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,444.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,667.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,532.50
|
| 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 |
$4,704.08
|
| 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 |
$1,481.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$785.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$5,556.00
|
| Rate for Payer: Multiplan Commercial |
$2,943.75
|
| Rate for Payer: Networks By Design Commercial |
$2,551.25
|
| Rate for Payer: Networks By Design Commercial |
$4,815.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$6,296.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,336.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,444.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,355.00
|
| 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 |
$3,704.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,962.50
|
| 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
|
IP
|
$7,408.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,481.60 |
| Max. Negotiated Rate |
$6,667.20 |
| Rate for Payer: Adventist Health Commercial |
$1,481.60
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,926.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,185.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,963.20
|
| Rate for Payer: Galaxy Health WC |
$6,296.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,444.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,667.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,704.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,370.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,481.60
|
| Rate for Payer: Multiplan Commercial |
$5,556.00
|
| Rate for Payer: Networks By Design Commercial |
$4,815.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,296.80
|
|
|
HC ESOPHAGUS ENDOSCOPY W RMVL FB
|
Facility
|
IP
|
$4,733.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
900501291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$946.60 |
| Max. Negotiated Rate |
$4,259.70 |
| Rate for Payer: Adventist Health Commercial |
$946.60
|
| Rate for Payer: Cash Price |
$2,129.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,786.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,313.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,893.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,893.20
|
| Rate for Payer: Galaxy Health WC |
$4,023.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,839.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,259.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,005.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,792.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.60
|
| Rate for Payer: Multiplan Commercial |
$3,549.75
|
| Rate for Payer: Networks By Design Commercial |
$3,076.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,023.05
|
|
|
HC ESOPHAGUS ENDOSCOPY W RMVL FB
|
Facility
|
OP
|
$4,733.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
900501291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$946.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Cash Price |
$2,129.85
|
| Rate for Payer: Cash Price |
$2,129.85
|
| Rate for Payer: Cash Price |
$2,129.85
|
| Rate for Payer: Cash Price |
$2,129.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,786.40
|
| Rate for Payer: Cigna of CA HMO |
$3,029.12
|
| Rate for Payer: Cigna of CA PPO |
$3,502.42
|
| 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 |
$3,313.10
|
| 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 |
$4,023.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,839.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,259.70
|
| 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 |
$3,005.45
|
| 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 |
$946.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,549.75
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$3,076.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Prime Health Services Commercial |
$4,023.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,839.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,366.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,366.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,366.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,366.50
|
| 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
|
$4,733.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
902100066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$946.60 |
| Max. Negotiated Rate |
$4,259.70 |
| Rate for Payer: Adventist Health Commercial |
$946.60
|
| Rate for Payer: Cash Price |
$2,129.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,786.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,313.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,893.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,893.20
|
| Rate for Payer: Galaxy Health WC |
$4,023.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,839.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,259.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,005.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,792.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.60
|
| Rate for Payer: Multiplan Commercial |
$3,549.75
|
| Rate for Payer: Networks By Design Commercial |
$3,076.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,023.05
|
|
|
HC ESOPHAGUS ENDOSCOPY W/RMVL FB
|
Facility
|
OP
|
$4,733.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
902100066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$946.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Cash Price |
$2,129.85
|
| Rate for Payer: Cash Price |
$2,129.85
|
| Rate for Payer: Cash Price |
$2,129.85
|
| Rate for Payer: Cash Price |
$2,129.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,786.40
|
| Rate for Payer: Cigna of CA HMO |
$3,029.12
|
| Rate for Payer: Cigna of CA PPO |
$3,502.42
|
| 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 |
$3,313.10
|
| 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 |
$4,023.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,839.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,259.70
|
| 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 |
$3,005.45
|
| 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 |
$946.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,549.75
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$3,076.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Prime Health Services Commercial |
$4,023.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,839.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,366.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,366.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,366.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,366.50
|
| 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 ESOPH BLLN DISTENSION PROVOCAT
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
CPT 91040
|
| Hospital Charge Code |
906791040
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$335.20 |
| Max. Negotiated Rate |
$1,508.40 |
| Rate for Payer: Adventist Health Commercial |
$335.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,340.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,173.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.40
|
| Rate for Payer: EPIC Health Plan Senior |
$670.40
|
| Rate for Payer: Galaxy Health WC |
$1,424.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,508.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,064.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$988.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.20
|
| Rate for Payer: Multiplan Commercial |
$1,257.00
|
| Rate for Payer: Networks By Design Commercial |
$1,089.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,424.60
|
|
|
HC ESOPH BLLN DISTENSION PROVOCAT
|
Facility
|
OP
|
$926.00
|
|
|
Service Code
|
CPT 91040
|
| Hospital Charge Code |
906791040
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Adventist Health Commercial |
$335.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,082.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,082.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$538.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$974.93
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,340.80
|
| Rate for Payer: Central Health Plan Commercial |
$740.80
|
| Rate for Payer: Cigna of CA HMO |
$592.64
|
| Rate for Payer: Cigna of CA HMO |
$1,072.64
|
| Rate for Payer: Cigna of CA PPO |
$1,240.24
|
| Rate for Payer: Cigna of CA PPO |
$685.24
|
| 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 |
$1,173.20
|
| 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 |
$1,424.60
|
| Rate for Payer: Galaxy Health WC |
$787.10
|
| Rate for Payer: Global Benefits Group Commercial |
$555.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$833.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,508.40
|
| 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 |
$716.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$716.55
|
| 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 |
$1,064.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$588.01
|
| 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 |
$335.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$1,257.00
|
| Rate for Payer: Multiplan Commercial |
$694.50
|
| Rate for Payer: Networks By Design Commercial |
$1,089.40
|
| Rate for Payer: Networks By Design Commercial |
$601.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$787.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,424.60
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,005.60
|
| 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 |
$838.00
|
| 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 DIAG DILATION
|
Facility
|
IP
|
$5,718.00
|
|
|
Service Code
|
CPT 43226
|
| Hospital Charge Code |
906743226
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,143.60 |
| Max. Negotiated Rate |
$5,146.20 |
| Rate for Payer: Adventist Health Commercial |
$1,143.60
|
| Rate for Payer: Cash Price |
$2,573.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,574.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,002.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,287.20
|
| Rate for Payer: Galaxy Health WC |
$4,860.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,430.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,146.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,630.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,373.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,143.60
|
| Rate for Payer: Multiplan Commercial |
$4,288.50
|
| Rate for Payer: Networks By Design Commercial |
$3,716.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,860.30
|
|
|
HC ESOPH DIAG DILATION
|
Facility
|
OP
|
$5,718.00
|
|
|
Service Code
|
CPT 43226
|
| Hospital Charge Code |
906743226
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$307.36 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,143.60
|
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,573.10
|
| Rate for Payer: Cash Price |
$2,573.10
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$2,573.10
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,445.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,574.40
|
| Rate for Payer: Cigna of CA HMO |
$1,956.48
|
| Rate for Payer: Cigna of CA HMO |
$3,659.52
|
| Rate for Payer: Cigna of CA PPO |
$4,231.32
|
| Rate for Payer: Cigna of CA PPO |
$2,262.18
|
| 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 |
$2,139.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,002.60
|
| 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 |
$4,860.30
|
| 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 |
$3,430.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,751.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,146.20
|
| 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 |
$307.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$307.36
|
| 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 |
$1,941.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,630.93
|
| 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 |
$1,143.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$4,288.50
|
| Rate for Payer: Multiplan Commercial |
$2,292.75
|
| Rate for Payer: Networks By Design Commercial |
$3,716.70
|
| Rate for Payer: Networks By Design Commercial |
$1,987.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Prime Health Services Commercial |
$2,598.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,860.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,834.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,430.80
|
| 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 |
$2,859.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,528.50
|
| 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
|
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43197
|
| Hospital Charge Code |
906743197
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$119.11 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| 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 |
$1,255.95
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,193.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,232.80
|
| Rate for Payer: Cigna of CA HMO |
$954.88
|
| Rate for Payer: Cigna of CA HMO |
$1,786.24
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| Rate for Payer: Cigna of CA PPO |
$1,104.08
|
| 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 |
$1,044.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,953.70
|
| 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: Health Management Network EPO/PPO |
$1,342.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,511.90
|
| 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 |
$119.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$119.11
|
| 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 |
$947.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,772.29
|
| 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 |
$558.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,093.25
|
| Rate for Payer: Multiplan Commercial |
$1,119.00
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$895.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| 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 |
$1,395.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.00
|
| 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 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 |
$2,511.90 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,232.80
|
| 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: Health Management Network EPO/PPO |
$2,511.90
|
| 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 |
$558.20
|
| Rate for Payer: Multiplan Commercial |
$2,093.25
|
| 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 |
$141.52 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| 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 |
$1,255.95
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,193.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,232.80
|
| Rate for Payer: Cigna of CA HMO |
$954.88
|
| Rate for Payer: Cigna of CA HMO |
$1,786.24
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| Rate for Payer: Cigna of CA PPO |
$1,104.08
|
| 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 |
$1,044.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,953.70
|
| 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: Health Management Network EPO/PPO |
$1,342.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,511.90
|
| 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 |
$141.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.52
|
| 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 |
$947.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,772.29
|
| 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 |
$558.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,093.25
|
| Rate for Payer: Multiplan Commercial |
$1,119.00
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$895.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| 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 |
$1,395.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.00
|
| 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 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 |
$2,511.90 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,232.80
|
| 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: Health Management Network EPO/PPO |
$2,511.90
|
| 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 |
$558.20
|
| Rate for Payer: Multiplan Commercial |
$2,093.25
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
|
|
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 |
$292.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$674.60
|
| Rate for Payer: Adventist Health Commercial |
$450.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| 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 |
$1,517.85
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,802.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,698.40
|
| Rate for Payer: Cigna of CA HMO |
$1,441.92
|
| Rate for Payer: Cigna of CA HMO |
$2,158.72
|
| Rate for Payer: Cigna of CA PPO |
$2,496.02
|
| Rate for Payer: Cigna of CA PPO |
$1,667.22
|
| 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 |
$1,577.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,361.10
|
| 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: Health Management Network EPO/PPO |
$2,027.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,035.70
|
| 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 |
$292.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$292.00
|
| 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 |
$1,430.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,141.86
|
| 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 |
$674.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,529.75
|
| Rate for Payer: Multiplan Commercial |
$1,689.75
|
| Rate for Payer: Networks By Design Commercial |
$2,192.45
|
| Rate for Payer: Networks By Design Commercial |
$1,464.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,867.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,351.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,023.80
|
| 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 |
$1,686.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,126.50
|
| 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 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 |
$3,035.70 |
| Rate for Payer: Adventist Health Commercial |
$674.60
|
| Rate for Payer: Cash Price |
$1,517.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,698.40
|
| 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: Health Management Network EPO/PPO |
$3,035.70
|
| 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 |
$674.60
|
| Rate for Payer: Multiplan Commercial |
$2,529.75
|
| Rate for Payer: Networks By Design Commercial |
$2,192.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,867.05
|
|
|
HC ESOPH DIAG FLEX TRANS W ENDO MUC
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
CPT 43211
|
| Hospital Charge Code |
906743211
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$363.07 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,193.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,785.60
|
| Rate for Payer: Cigna of CA HMO |
$954.88
|
| Rate for Payer: Cigna of CA HMO |
$1,428.48
|
| Rate for Payer: Cigna of CA PPO |
$1,651.68
|
| Rate for Payer: Cigna of CA PPO |
$1,104.08
|
| 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 |
$1,044.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,562.40
|
| 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 |
$1,897.20
|
| 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 |
$1,339.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,342.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,008.80
|
| 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 |
$363.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$363.07
|
| 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 |
$947.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,417.32
|
| 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 |
$446.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: Multiplan Commercial |
$1,119.00
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$895.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,339.20
|
| 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 |
$1,116.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.00
|
| 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
|
|
