|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
IP
|
$4,574.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
750
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,742.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,831.31
|
| 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 ESOPHAGEAL DILATATION
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Adventist Health Commercial |
$210.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.40
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$683.80
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
|
|
HC ESOPHAGEAL DILATATION
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.31 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Adventist Health Commercial |
$210.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$638.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$578.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$789.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$638.56
|
| Rate for Payer: Blue Shield of California EPN |
$417.64
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: Cigna of CA HMO |
$673.28
|
| Rate for Payer: Cigna of CA PPO |
$778.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$894.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$894.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.45
|
| Rate for Payer: InnovAge PACE Commercial |
$526.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$736.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$736.40
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$683.80
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: Riverside University Health System MISP |
$420.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$631.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$631.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$526.00
|
| Rate for Payer: United Healthcare All Other HMO |
$526.00
|
| Rate for Payer: United Healthcare HMO Rider |
$526.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.20
|
| Rate for Payer: Vantage Medical Group Senior |
$894.20
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
OP
|
$4,353.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$158.17 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$870.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,700.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,394.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,264.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,958.85
|
| Rate for Payer: Cash Price |
$1,958.85
|
| Rate for Payer: Cash Price |
$1,958.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,482.40
|
| Rate for Payer: Cigna of CA HMO |
$2,785.92
|
| Rate for Payer: Cigna of CA PPO |
$3,221.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,700.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,700.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,700.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,741.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,741.20
|
| Rate for Payer: Galaxy Health WC |
$3,700.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,611.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,917.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.17
|
| Rate for Payer: InnovAge PACE Commercial |
$2,176.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,903.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,694.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,047.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,047.10
|
| Rate for Payer: Multiplan Commercial |
$3,264.75
|
| Rate for Payer: Networks By Design Commercial |
$2,829.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,700.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,741.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,611.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,611.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,700.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,700.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,700.05
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
IP
|
$6,570.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,314.00 |
| Max. Negotiated Rate |
$5,913.00 |
| Rate for Payer: Adventist Health Commercial |
$1,314.00
|
| Rate for Payer: Cash Price |
$2,956.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,256.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,628.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,628.00
|
| Rate for Payer: Galaxy Health WC |
$5,584.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,913.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,382.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,503.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,066.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.00
|
| Rate for Payer: Multiplan Commercial |
$4,927.50
|
| Rate for Payer: Networks By Design Commercial |
$4,270.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,584.50
|
|
|
HC ESOPHAGOSCOPY RIGID TRANSORAL
|
Facility
|
IP
|
$11,735.00
|
|
|
Service Code
|
CPT 43180
|
| Hospital Charge Code |
906743180
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,347.00 |
| Max. Negotiated Rate |
$10,561.50 |
| Rate for Payer: Adventist Health Commercial |
$2,347.00
|
| Rate for Payer: Cash Price |
$5,280.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,388.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,694.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,694.00
|
| Rate for Payer: Galaxy Health WC |
$9,974.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,041.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,561.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,827.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,471.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,263.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,347.00
|
| Rate for Payer: Multiplan Commercial |
$8,801.25
|
| Rate for Payer: Networks By Design Commercial |
$7,627.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,974.75
|
|
|
HC ESOPHAGOSCOPY RIGID TRANSORAL
|
Facility
|
OP
|
$11,735.00
|
|
|
Service Code
|
CPT 43180
|
| Hospital Charge Code |
906743180
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$835.66 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,347.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,516.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$5,280.75
|
| Rate for Payer: Cash Price |
$5,280.75
|
| Rate for Payer: Cash Price |
$5,280.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,388.00
|
| Rate for Payer: Cigna of CA HMO |
$7,510.40
|
| Rate for Payer: Cigna of CA PPO |
$8,683.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,268.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,516.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,147.19
|
| Rate for Payer: EPIC Health Plan Senior |
$7,516.44
|
| Rate for Payer: Galaxy Health WC |
$9,974.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,041.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,561.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,326.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$835.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,516.44
|
| Rate for Payer: InnovAge PACE Commercial |
$11,274.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,827.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,516.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,347.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,072.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,072.03
|
| Rate for Payer: Multiplan Commercial |
$8,801.25
|
| Rate for Payer: Networks By Design Commercial |
$7,627.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,516.44
|
| Rate for Payer: Prime Health Services Commercial |
$9,974.75
|
| Rate for Payer: Prime Health Services Medicare |
$7,967.43
|
| Rate for Payer: Riverside University Health System MISP |
$8,268.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,041.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,019.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,516.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Vantage Medical Group Senior |
$7,516.44
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,742.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,831.31
|
| 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 |
$6,248.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| 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 |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| 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 |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| 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 |
$2,410.32
|
| 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 |
$2,554.94
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| 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 |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ESOPHAGOSCOPY W OPTICAL ENDOMI
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
CPT 43206
|
| Hospital Charge Code |
906743206
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$408.20 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$408.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,632.80
|
| Rate for Payer: Cigna of CA HMO |
$1,306.24
|
| Rate for Payer: Cigna of CA PPO |
$1,510.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$1,734.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,224.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,836.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,361.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$1,530.75
|
| Rate for Payer: Networks By Design Commercial |
$1,326.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$1,734.85
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,224.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$2,036.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,889.81
|
| 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/WO SPECIMEN
|
Facility
|
OP
|
$3,070.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$290.08 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$614.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,381.50
|
| 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: Cigna of CA HMO |
$1,964.80
|
| Rate for Payer: Cigna of CA PPO |
$2,271.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$2,609.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,842.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,763.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$290.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,047.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,302.50
|
| Rate for Payer: Networks By Design Commercial |
$1,995.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$2,609.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,842.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$3,064.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,750.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,843.69
|
| 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
|
$3,070.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$614.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| 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 |
$1,381.50
|
| 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: Cigna of CA HMO |
$1,964.80
|
| Rate for Payer: Cigna of CA PPO |
$2,271.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$2,609.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,842.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,763.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,047.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,302.50
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$1,995.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,609.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| 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 HMO |
$1,535.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,535.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,535.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$3,064.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,750.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,843.69
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$4,941.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,822.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,585.55
|
| 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 CELLVIZIO
|
Facility
|
OP
|
$3,925.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$785.00 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$785.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| 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: Central Health Plan Commercial |
$3,140.00
|
| Rate for Payer: Cigna of CA HMO |
$2,512.00
|
| Rate for Payer: Cigna of CA PPO |
$2,904.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$3,336.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,355.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,532.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,617.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$785.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,943.75
|
| Rate for Payer: Networks By Design Commercial |
$2,551.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$3,336.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,355.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
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 |
$4,259.70 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| 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 |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$4,023.05
|
| 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 |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,156.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| 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 |
$2,410.32
|
| 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 |
$2,554.94
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| 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 |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$3,156.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,803.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,929.73
|
| 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 |
$4,259.70 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| 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 |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$4,023.05
|
| 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 |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,156.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| 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 |
$2,410.32
|
| 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 |
$2,554.94
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| 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 |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$3,156.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,803.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,929.73
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$1,117.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$638.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.44
|
| 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 Medi-Cal |
$674.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,082.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$543.84
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Central Health Plan Commercial |
$740.80
|
| Rate for Payer: Cigna of CA HMO |
$592.64
|
| Rate for Payer: Cigna of CA PPO |
$685.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$787.10
|
| Rate for Payer: Global Benefits Group Commercial |
$555.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$833.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$716.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: InnovAge PACE Commercial |
$1,011.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$617.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$903.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$694.50
|
| Rate for Payer: Networks By Design Commercial |
$601.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$674.18
|
| Rate for Payer: Prime Health Services Commercial |
$787.10
|
| Rate for Payer: Prime Health Services Medicare |
$714.63
|
| Rate for Payer: Riverside University Health System MISP |
$741.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$809.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC ESOPH 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: 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 Permanente of CA Commercial/Self Funded |
$3,813.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,178.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,539.44
|
| 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
|
$3,057.00
|
|
|
Service Code
|
CPT 43226
|
| Hospital Charge Code |
906743226
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$307.36 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,375.65
|
| 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: Cigna of CA HMO |
$1,956.48
|
| Rate for Payer: Cigna of CA PPO |
$2,262.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$2,598.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,834.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,751.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$307.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,039.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$2,292.75
|
| Rate for Payer: Networks By Design Commercial |
$1,987.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$2,598.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,834.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
