|
HC ESOPH DIAG W/LESION
|
Facility
|
OP
|
$3,163.00
|
|
|
Service Code
|
CPT 43216
|
| Hospital Charge Code |
906743216
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$340.66 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$632.60
|
| 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 |
$1,739.65
|
| Rate for Payer: Cash Price |
$1,739.65
|
| Rate for Payer: Cash Price |
$1,739.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,530.40
|
| Rate for Payer: Cigna of CA HMO |
$2,024.32
|
| Rate for Payer: Cigna of CA PPO |
$2,340.62
|
| 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 |
$2,688.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,897.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,846.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$340.66
|
| 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 |
$2,109.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.60
|
| 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 |
$2,372.25
|
| Rate for Payer: Networks By Design Commercial |
$2,055.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$2,688.55
|
| 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 |
$1,897.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| 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 |
$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 W/LESION
|
Facility
|
IP
|
$3,163.00
|
|
|
Service Code
|
CPT 43216
|
| Hospital Charge Code |
906743216
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$632.60 |
| Max. Negotiated Rate |
$2,846.70 |
| Rate for Payer: Adventist Health Commercial |
$632.60
|
| Rate for Payer: Cash Price |
$1,739.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,530.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,265.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,265.20
|
| Rate for Payer: Galaxy Health WC |
$2,688.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,897.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,846.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,109.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,205.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,957.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.60
|
| Rate for Payer: Multiplan Commercial |
$2,372.25
|
| Rate for Payer: Networks By Design Commercial |
$2,055.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,688.55
|
|
|
HC ESOPH DIAG W/RMVL OF FB
|
Facility
|
OP
|
$3,163.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
906743215
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$384.21 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$632.60
|
| 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 |
$1,739.65
|
| Rate for Payer: Cash Price |
$1,739.65
|
| Rate for Payer: Cash Price |
$1,739.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,530.40
|
| Rate for Payer: Cigna of CA HMO |
$2,024.32
|
| Rate for Payer: Cigna of CA PPO |
$2,340.62
|
| 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 |
$2,688.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,897.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,846.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$384.21
|
| 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 |
$2,109.72
|
| 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 |
$632.60
|
| 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 |
$2,372.25
|
| Rate for Payer: Networks By Design Commercial |
$2,055.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$2,688.55
|
| 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 |
$1,897.80
|
| 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 W/RMVL OF FB
|
Facility
|
IP
|
$3,163.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
906743215
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$632.60 |
| Max. Negotiated Rate |
$2,846.70 |
| Rate for Payer: Adventist Health Commercial |
$632.60
|
| Rate for Payer: Cash Price |
$1,739.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,530.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,265.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,265.20
|
| Rate for Payer: Galaxy Health WC |
$2,688.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,897.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,846.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,109.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,205.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,957.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.60
|
| Rate for Payer: Multiplan Commercial |
$2,372.25
|
| Rate for Payer: Networks By Design Commercial |
$2,055.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,688.55
|
|
|
HC ESOPH DIAG W/SCLEROSIS
|
Facility
|
IP
|
$3,566.00
|
|
|
Service Code
|
CPT 43204
|
| Hospital Charge Code |
906743204
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$713.20 |
| Max. Negotiated Rate |
$3,209.40 |
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| Rate for Payer: Cash Price |
$1,961.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,852.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,426.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,426.40
|
| Rate for Payer: Galaxy Health WC |
$3,031.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,139.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,209.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,378.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,358.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,207.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.20
|
| Rate for Payer: Multiplan Commercial |
$2,674.50
|
| Rate for Payer: Networks By Design Commercial |
$2,317.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,031.10
|
|
|
HC ESOPH DIAG W/SCLEROSIS
|
Facility
|
OP
|
$3,566.00
|
|
|
Service Code
|
CPT 43204
|
| Hospital Charge Code |
906743204
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$480.28 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| 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 |
$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 |
$1,961.30
|
| Rate for Payer: Cash Price |
$1,961.30
|
| Rate for Payer: Cash Price |
$1,961.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,852.80
|
| Rate for Payer: Cigna of CA HMO |
$2,282.24
|
| Rate for Payer: Cigna of CA PPO |
$2,638.84
|
| 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 |
$3,031.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,139.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,209.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$480.28
|
| 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 |
$2,378.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.20
|
| 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 |
$2,674.50
|
| Rate for Payer: Networks By Design Commercial |
$2,317.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$3,031.10
|
| 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 |
$2,139.60
|
| 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 ESOPH DIAG W/SNARE
|
Facility
|
OP
|
$3,566.00
|
|
|
Service Code
|
CPT 43217
|
| Hospital Charge Code |
906743217
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$244.62 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| 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 |
$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 |
$1,961.30
|
| Rate for Payer: Cash Price |
$1,961.30
|
| Rate for Payer: Cash Price |
$1,961.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,852.80
|
| Rate for Payer: Cigna of CA HMO |
$2,282.24
|
| Rate for Payer: Cigna of CA PPO |
$2,638.84
|
| 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 |
$3,031.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,139.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,209.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$244.62
|
| 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 |
$2,378.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.20
|
| 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 |
$2,674.50
|
| Rate for Payer: Networks By Design Commercial |
$2,317.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$3,031.10
|
| 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 |
$2,139.60
|
| 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 ESOPH DIAG W/SNARE
|
Facility
|
IP
|
$3,566.00
|
|
|
Service Code
|
CPT 43217
|
| Hospital Charge Code |
906743217
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$713.20 |
| Max. Negotiated Rate |
$3,209.40 |
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| Rate for Payer: Cash Price |
$1,961.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,852.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,426.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,426.40
|
| Rate for Payer: Galaxy Health WC |
$3,031.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,139.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,209.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,378.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,358.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,207.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.20
|
| Rate for Payer: Multiplan Commercial |
$2,674.50
|
| Rate for Payer: Networks By Design Commercial |
$2,317.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,031.10
|
|
|
HC ESOPH DIAG W/SUBMUC INJ
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
CPT 43201
|
| Hospital Charge Code |
906743201
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$360.51 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$612.00
|
| 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 |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,448.00
|
| Rate for Payer: Cigna of CA HMO |
$1,958.40
|
| Rate for Payer: Cigna of CA PPO |
$2,264.40
|
| 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 |
$2,601.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,836.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,754.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$360.51
|
| 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 |
$2,041.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.00
|
| 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 |
$2,295.00
|
| Rate for Payer: Networks By Design Commercial |
$1,989.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$2,601.00
|
| 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 |
$1,836.00
|
| 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 W/SUBMUC INJ
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
CPT 43201
|
| Hospital Charge Code |
906743201
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$612.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,448.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,224.00
|
| Rate for Payer: Galaxy Health WC |
$2,601.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,836.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,754.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,041.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,165.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,894.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.00
|
| Rate for Payer: Multiplan Commercial |
$2,295.00
|
| Rate for Payer: Networks By Design Commercial |
$1,989.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,601.00
|
|
|
HC ESOPH ENDOSCOPY ABLATION
|
Facility
|
OP
|
$4,827.00
|
|
|
Service Code
|
CPT 43228
|
| Hospital Charge Code |
906743228
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$965.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$965.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,102.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,654.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,620.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,337.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,834.90
|
| 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 |
$2,654.85
|
| Rate for Payer: Cash Price |
$2,654.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,861.60
|
| Rate for Payer: Cigna of CA HMO |
$3,089.28
|
| Rate for Payer: Cigna of CA PPO |
$3,571.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,102.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,102.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,102.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,930.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,930.80
|
| Rate for Payer: Galaxy Health WC |
$4,102.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,896.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,344.30
|
| Rate for Payer: InnovAge PACE Commercial |
$2,413.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,219.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,839.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,987.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$965.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,378.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,378.90
|
| Rate for Payer: Multiplan Commercial |
$3,620.25
|
| Rate for Payer: Networks By Design Commercial |
$3,137.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,102.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,930.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,896.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,896.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,413.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,413.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,413.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,413.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,102.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,102.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,102.95
|
|
|
HC ESOPH ENDOSCOPY ABLATION
|
Facility
|
IP
|
$4,827.00
|
|
|
Service Code
|
CPT 43228
|
| Hospital Charge Code |
906743228
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$965.40 |
| Max. Negotiated Rate |
$4,344.30 |
| Rate for Payer: Adventist Health Commercial |
$965.40
|
| Rate for Payer: Cash Price |
$2,654.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,861.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,930.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,930.80
|
| Rate for Payer: Galaxy Health WC |
$4,102.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,896.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,344.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,219.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,839.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,987.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$965.40
|
| Rate for Payer: Multiplan Commercial |
$3,620.25
|
| Rate for Payer: Networks By Design Commercial |
$3,137.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,102.95
|
|
|
HC ESOPH ENDOSCOPY REP
|
Facility
|
OP
|
$3,057.00
|
|
|
Service Code
|
CPT 43227
|
| Hospital Charge Code |
906743227
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$296.48 |
| 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 |
$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 |
$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 |
$1,681.35
|
| 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 |
$296.48
|
| 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 |
$327.50
|
| 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 ENDOSCOPY REP
|
Facility
|
IP
|
$3,057.00
|
|
|
Service Code
|
CPT 43227
|
| Hospital Charge Code |
906743227
|
|
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 IMPED FUNC TST GT 1HR-24HR
|
Facility
|
IP
|
$1,428.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
906791037
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$1,285.20 |
| Rate for Payer: Adventist Health Commercial |
$285.60
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,142.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.20
|
| Rate for Payer: EPIC Health Plan Senior |
$571.20
|
| Rate for Payer: Galaxy Health WC |
$1,213.80
|
| Rate for Payer: Global Benefits Group Commercial |
$856.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,285.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$952.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$883.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$1,071.00
|
| Rate for Payer: Networks By Design Commercial |
$928.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.80
|
|
|
HC ESOPH IMPED FUNC TST GT 1HR-24HR
|
Facility
|
OP
|
$1,428.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
906791037
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$230.86 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$285.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$707.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$838.66
|
| 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 |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,142.40
|
| Rate for Payer: Cigna of CA HMO |
$913.92
|
| Rate for Payer: Cigna of CA PPO |
$1,056.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$1,213.80
|
| Rate for Payer: Global Benefits Group Commercial |
$856.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,285.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$230.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$952.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$1,071.00
|
| Rate for Payer: Networks By Design Commercial |
$928.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.80
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$856.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.79
|
| 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 |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC ESOPH IMPED FUNC TST UP TO 1HR
|
Facility
|
IP
|
$1,428.00
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
906791038
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$1,285.20 |
| Rate for Payer: Adventist Health Commercial |
$285.60
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,142.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.20
|
| Rate for Payer: EPIC Health Plan Senior |
$571.20
|
| Rate for Payer: Galaxy Health WC |
$1,213.80
|
| Rate for Payer: Global Benefits Group Commercial |
$856.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,285.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$952.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$883.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$1,071.00
|
| Rate for Payer: Networks By Design Commercial |
$928.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.80
|
|
|
HC ESOPH IMPED FUNC TST UP TO 1HR
|
Facility
|
OP
|
$1,428.00
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
906791038
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$285.60
|
| 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 |
$490.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$838.66
|
| 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 |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,142.40
|
| Rate for Payer: Cigna of CA HMO |
$913.92
|
| Rate for Payer: Cigna of CA PPO |
$1,056.72
|
| 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 |
$1,213.80
|
| Rate for Payer: Global Benefits Group Commercial |
$856.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,285.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$195.80
|
| 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 |
$952.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.60
|
| 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 |
$1,071.00
|
| Rate for Payer: Networks By Design Commercial |
$928.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$674.18
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.80
|
| 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 |
$856.80
|
| 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 LESION ABLATION
|
Facility
|
OP
|
$4,675.00
|
|
|
Service Code
|
CPT 43229
|
| Hospital Charge Code |
900100016
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$308.02 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$935.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,834.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| 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 |
$2,571.25
|
| Rate for Payer: Cash Price |
$2,571.25
|
| Rate for Payer: Cash Price |
$2,571.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,740.00
|
| Rate for Payer: Cigna of CA HMO |
$2,992.00
|
| Rate for Payer: Cigna of CA PPO |
$3,459.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,525.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4,834.04
|
| Rate for Payer: Galaxy Health WC |
$3,973.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,805.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,207.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$308.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: InnovAge PACE Commercial |
$7,251.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,118.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,477.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,477.61
|
| Rate for Payer: Multiplan Commercial |
$3,506.25
|
| Rate for Payer: Networks By Design Commercial |
$3,038.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Prime Health Services Commercial |
$3,973.75
|
| Rate for Payer: Prime Health Services Medicare |
$5,124.08
|
| Rate for Payer: Riverside University Health System MISP |
$5,317.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,805.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.85
|
| 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 |
$4,834.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
|
HC ESOPH LESION ABLATION
|
Facility
|
IP
|
$4,675.00
|
|
|
Service Code
|
CPT 43229
|
| Hospital Charge Code |
900100016
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$935.00 |
| Max. Negotiated Rate |
$4,207.50 |
| Rate for Payer: Adventist Health Commercial |
$935.00
|
| Rate for Payer: Cash Price |
$2,571.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,740.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,870.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,870.00
|
| Rate for Payer: Galaxy Health WC |
$3,973.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,805.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,207.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,118.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,781.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,893.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.00
|
| Rate for Payer: Multiplan Commercial |
$3,506.25
|
| Rate for Payer: Networks By Design Commercial |
$3,038.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,973.75
|
|
|
HC ESOPH MOTILITY STUDY W/MECH/SI
|
Facility
|
OP
|
$1,603.00
|
|
|
Service Code
|
CPT 91013
|
| Hospital Charge Code |
906791011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$320.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,362.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$881.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,202.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$941.44
|
| 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 |
$881.65
|
| Rate for Payer: Cash Price |
$881.65
|
| Rate for Payer: Cash Price |
$881.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,282.40
|
| Rate for Payer: Cigna of CA HMO |
$1,025.92
|
| Rate for Payer: Cigna of CA PPO |
$1,186.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,362.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,362.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,362.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$641.20
|
| Rate for Payer: EPIC Health Plan Senior |
$641.20
|
| Rate for Payer: Galaxy Health WC |
$1,362.55
|
| Rate for Payer: Global Benefits Group Commercial |
$961.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,442.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.67
|
| Rate for Payer: InnovAge PACE Commercial |
$801.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,069.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$992.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,122.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,122.10
|
| Rate for Payer: Multiplan Commercial |
$1,202.25
|
| Rate for Payer: Networks By Design Commercial |
$1,041.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,362.55
|
| Rate for Payer: Riverside University Health System MISP |
$641.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$961.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$961.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,362.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,362.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,362.55
|
|
|
HC ESOPH MOTILITY STUDY W/MECH/SI
|
Facility
|
IP
|
$1,603.00
|
|
|
Service Code
|
CPT 91013
|
| Hospital Charge Code |
906791011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$320.60 |
| Max. Negotiated Rate |
$1,442.70 |
| Rate for Payer: Adventist Health Commercial |
$320.60
|
| Rate for Payer: Cash Price |
$881.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,282.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$641.20
|
| Rate for Payer: EPIC Health Plan Senior |
$641.20
|
| Rate for Payer: Galaxy Health WC |
$1,362.55
|
| Rate for Payer: Global Benefits Group Commercial |
$961.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,442.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,069.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$610.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$992.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.60
|
| Rate for Payer: Multiplan Commercial |
$1,202.25
|
| Rate for Payer: Networks By Design Commercial |
$1,041.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,362.55
|
|
|
HC ESOPH MOTIL MANOMETRIC
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
906791010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$451.00 |
| Max. Negotiated Rate |
$2,029.50 |
| Rate for Payer: Adventist Health Commercial |
$451.00
|
| Rate for Payer: Cash Price |
$1,240.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,804.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$902.00
|
| Rate for Payer: EPIC Health Plan Senior |
$902.00
|
| Rate for Payer: Galaxy Health WC |
$1,916.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,353.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,029.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,504.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,395.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.00
|
| Rate for Payer: Multiplan Commercial |
$1,691.25
|
| Rate for Payer: Networks By Design Commercial |
$1,465.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,916.75
|
|
|
HC ESOPH MOTIL MANOMETRIC
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
906791010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$118.87 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$451.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$674.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$217.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,324.36
|
| 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 |
$1,240.25
|
| Rate for Payer: Cash Price |
$1,240.25
|
| Rate for Payer: Cash Price |
$1,240.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,804.00
|
| Rate for Payer: Cigna of CA HMO |
$1,443.20
|
| Rate for Payer: Cigna of CA PPO |
$1,668.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,916.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,353.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,029.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.87
|
| 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 |
$1,504.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.00
|
| 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 |
$1,691.25
|
| Rate for Payer: Networks By Design Commercial |
$1,465.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$674.18
|
| Rate for Payer: Prime Health Services Commercial |
$1,916.75
|
| 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 |
$1,353.00
|
| 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 ESOPHOGRAM
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Adventist Health Commercial |
$239.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$727.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$231.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.98
|
| Rate for Payer: Blue Shield of California Commercial |
$727.19
|
| Rate for Payer: Blue Shield of California EPN |
$475.61
|
| Rate for Payer: Cash Price |
$658.90
|
| Rate for Payer: Cash Price |
$658.90
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: Cigna of CA HMO |
$766.72
|
| Rate for Payer: Cigna of CA PPO |
$886.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$718.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$718.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
