|
HC ESOPHAGOSCOPY W OPTICAL ENDOMI
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
CPT 43206
|
| Hospital Charge Code |
906743206
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$408.20 |
| Max. Negotiated Rate |
$1,836.90 |
| Rate for Payer: Adventist Health Commercial |
$408.20
|
| Rate for Payer: Cash Price |
$1,122.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,632.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$816.40
|
| Rate for Payer: EPIC Health Plan Senior |
$816.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,361.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$777.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,263.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$1,530.75
|
| Rate for Payer: Networks By Design Commercial |
$1,326.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,734.85
|
|
|
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 |
$1,122.55
|
| Rate for Payer: Cash Price |
$1,122.55
|
| Rate for Payer: Cash Price |
$1,122.55
|
| 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/WO SPECIMEN
|
Facility
|
IP
|
$3,070.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$614.00 |
| Max. Negotiated Rate |
$2,763.00 |
| Rate for Payer: Adventist Health Commercial |
$614.00
|
| Rate for Payer: Cash Price |
$1,688.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,456.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,228.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,047.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,900.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.00
|
| Rate for Payer: Multiplan Commercial |
$2,302.50
|
| Rate for Payer: Networks By Design Commercial |
$1,995.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,609.50
|
|
|
HC ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
IP
|
$3,070.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$614.00 |
| Max. Negotiated Rate |
$2,763.00 |
| Rate for Payer: Adventist Health Commercial |
$614.00
|
| Rate for Payer: Cash Price |
$1,688.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,456.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,228.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,047.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,900.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.00
|
| Rate for Payer: Multiplan Commercial |
$2,302.50
|
| Rate for Payer: Networks By Design Commercial |
$1,995.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,609.50
|
|
|
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 |
$1,688.50
|
| Rate for Payer: Cash Price |
$1,688.50
|
| Rate for Payer: Cash Price |
$1,688.50
|
| 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
|
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 |
$1,688.50
|
| Rate for Payer: Cash Price |
$1,688.50
|
| Rate for Payer: Cash Price |
$1,688.50
|
| Rate for Payer: Cash Price |
$1,688.50
|
| 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 ESOPHAGUS CELLVIZIO
|
Facility
|
IP
|
$3,925.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$785.00 |
| Max. Negotiated Rate |
$3,532.50 |
| Rate for Payer: Adventist Health Commercial |
$785.00
|
| Rate for Payer: Cash Price |
$2,158.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,570.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,570.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,617.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,495.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,429.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$785.00
|
| Rate for Payer: Multiplan Commercial |
$2,943.75
|
| Rate for Payer: Networks By Design Commercial |
$2,551.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,336.25
|
|
|
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 |
$2,158.75
|
| Rate for Payer: Cash Price |
$2,158.75
|
| Rate for Payer: Cash Price |
$2,158.75
|
| 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 |
$2,603.15
|
| Rate for Payer: Cash Price |
$2,603.15
|
| Rate for Payer: Cash Price |
$2,603.15
|
| Rate for Payer: Cash Price |
$2,603.15
|
| 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 |
$2,603.15
|
| 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 |
$2,603.15
|
| Rate for Payer: Cash Price |
$2,603.15
|
| Rate for Payer: Cash Price |
$2,603.15
|
| Rate for Payer: Cash Price |
$2,603.15
|
| 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 |
$2,603.15
|
| 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
|
$926.00
|
|
|
Service Code
|
CPT 91040
|
| Hospital Charge Code |
906791040
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$833.40 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Cash Price |
$509.30
|
| Rate for Payer: Central Health Plan Commercial |
$740.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.40
|
| Rate for Payer: EPIC Health Plan Senior |
$370.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$617.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$573.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.20
|
| Rate for Payer: Multiplan Commercial |
$694.50
|
| Rate for Payer: Networks By Design Commercial |
$601.90
|
| Rate for Payer: Prime Health Services Commercial |
$787.10
|
|
|
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 |
$509.30
|
| Rate for Payer: Cash Price |
$509.30
|
| Rate for Payer: Cash Price |
$509.30
|
| 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
|
$3,057.00
|
|
|
Service Code
|
CPT 43226
|
| Hospital Charge Code |
906743226
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$611.40 |
| Max. Negotiated Rate |
$2,751.30 |
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Cash Price |
$1,681.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,222.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,222.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,039.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,164.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,892.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.40
|
| Rate for Payer: Multiplan Commercial |
$2,292.75
|
| Rate for Payer: Networks By Design Commercial |
$1,987.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,598.45
|
|
|
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 |
$1,681.35
|
| Rate for Payer: Cash Price |
$1,681.35
|
| Rate for Payer: Cash Price |
$1,681.35
|
| 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
|
|
|
HC ESOPH DIAG FLEX TRANSNASAL
|
Facility
|
IP
|
$1,492.00
|
|
|
Service Code
|
CPT 43197
|
| Hospital Charge Code |
906743197
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$298.40 |
| Max. Negotiated Rate |
$1,342.80 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Cash Price |
$820.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$596.80
|
| Rate for Payer: EPIC Health Plan Senior |
$596.80
|
| Rate for Payer: Galaxy Health WC |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,342.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$995.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$568.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$923.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.40
|
| Rate for Payer: Multiplan Commercial |
$1,119.00
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
|
|
HC ESOPH DIAG FLEX TRANSNASAL
|
Facility
|
OP
|
$1,492.00
|
|
|
Service Code
|
CPT 43197
|
| Hospital Charge Code |
906743197
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$119.11 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| 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 |
$820.60
|
| Rate for Payer: Cash Price |
$820.60
|
| Rate for Payer: Cash Price |
$820.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,193.60
|
| Rate for Payer: Cigna of CA HMO |
$954.88
|
| Rate for Payer: Cigna of CA PPO |
$1,104.08
|
| 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 |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,342.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$119.11
|
| 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 |
$995.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.40
|
| 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 |
$1,119.00
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
| 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 |
$895.20
|
| 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 ESOPH DIAG FLEX TRANSNASAL BIOPSY
|
Facility
|
OP
|
$1,492.00
|
|
|
Service Code
|
CPT 43198
|
| Hospital Charge Code |
906743198
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$141.52 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| 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 |
$820.60
|
| Rate for Payer: Cash Price |
$820.60
|
| Rate for Payer: Cash Price |
$820.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,193.60
|
| Rate for Payer: Cigna of CA HMO |
$954.88
|
| Rate for Payer: Cigna of CA PPO |
$1,104.08
|
| 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 |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,342.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.52
|
| 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 |
$995.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.40
|
| 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 |
$1,119.00
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
| 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 |
$895.20
|
| 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 ESOPH DIAG FLEX TRANSNASAL BIOPSY
|
Facility
|
IP
|
$1,492.00
|
|
|
Service Code
|
CPT 43198
|
| Hospital Charge Code |
906743198
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$298.40 |
| Max. Negotiated Rate |
$1,342.80 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Cash Price |
$820.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$596.80
|
| Rate for Payer: EPIC Health Plan Senior |
$596.80
|
| Rate for Payer: Galaxy Health WC |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,342.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$995.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$568.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$923.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.40
|
| Rate for Payer: Multiplan Commercial |
$1,119.00
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
|
|
HC ESOPH DIAG FLEX TRANSO DILA W BLLN 30MM
|
Facility
|
OP
|
$2,253.00
|
|
|
Service Code
|
CPT 43214
|
| Hospital Charge Code |
906743214
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$292.00 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$450.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| 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 |
$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 |
$1,239.15
|
| Rate for Payer: Cash Price |
$1,239.15
|
| Rate for Payer: Cash Price |
$1,239.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,802.40
|
| Rate for Payer: Cigna of CA HMO |
$1,441.92
|
| Rate for Payer: Cigna of CA PPO |
$1,667.22
|
| 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 |
$1,915.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,027.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$292.00
|
| 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 |
$1,502.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.60
|
| 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 |
$1,689.75
|
| Rate for Payer: Networks By Design Commercial |
$1,464.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.05
|
| 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 |
$1,351.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ESOPH DIAG FLEX TRANSO DILA W BLLN 30MM
|
Facility
|
IP
|
$2,253.00
|
|
|
Service Code
|
CPT 43214
|
| Hospital Charge Code |
906743214
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$450.60 |
| Max. Negotiated Rate |
$2,027.70 |
| Rate for Payer: Adventist Health Commercial |
$450.60
|
| Rate for Payer: Cash Price |
$1,239.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,802.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$901.20
|
| Rate for Payer: EPIC Health Plan Senior |
$901.20
|
| Rate for Payer: Galaxy Health WC |
$1,915.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,027.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,502.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,394.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.60
|
| Rate for Payer: Multiplan Commercial |
$1,689.75
|
| Rate for Payer: Networks By Design Commercial |
$1,464.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.05
|
|
|
HC ESOPH DIAG FLEX TRANS W ENDO MUC
|
Facility
|
OP
|
$1,492.00
|
|
|
Service Code
|
CPT 43211
|
| Hospital Charge Code |
906743211
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$298.40 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| 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 |
$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 |
$820.60
|
| Rate for Payer: Cash Price |
$820.60
|
| Rate for Payer: Cash Price |
$820.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,193.60
|
| Rate for Payer: Cigna of CA HMO |
$954.88
|
| Rate for Payer: Cigna of CA PPO |
$1,104.08
|
| 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 |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,342.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$363.07
|
| 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 |
$995.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.40
|
| 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 |
$1,119.00
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
| 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 |
$895.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ESOPH DIAG FLEX TRANS W ENDO MUC
|
Facility
|
IP
|
$1,492.00
|
|
|
Service Code
|
CPT 43211
|
| Hospital Charge Code |
906743211
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$298.40 |
| Max. Negotiated Rate |
$1,342.80 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Cash Price |
$820.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$596.80
|
| Rate for Payer: EPIC Health Plan Senior |
$596.80
|
| Rate for Payer: Galaxy Health WC |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,342.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$995.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$568.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$923.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.40
|
| Rate for Payer: Multiplan Commercial |
$1,119.00
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
|
|
HC ESOPH DIAG RIGID TRANSORAL
|
Facility
|
IP
|
$1,492.00
|
|
|
Service Code
|
CPT 43191
|
| Hospital Charge Code |
906743191
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$298.40 |
| Max. Negotiated Rate |
$1,342.80 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Cash Price |
$820.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$596.80
|
| Rate for Payer: EPIC Health Plan Senior |
$596.80
|
| Rate for Payer: Galaxy Health WC |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,342.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$995.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$568.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$923.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.40
|
| Rate for Payer: Multiplan Commercial |
$1,119.00
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
|
