|
HC ESOPHAGEAL DILATATION
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.06 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$506.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$578.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$578.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.20
|
| Rate for Payer: Blue Distinction Transplant |
$631.20
|
| Rate for Payer: Blue Shield of California Commercial |
$650.14
|
| Rate for Payer: Blue Shield of California EPN |
$511.27
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: Cigna of CA HMO |
$673.28
|
| Rate for Payer: Cigna of CA PPO |
$778.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$894.20
|
| Rate for Payer: Dignity Health Media |
$894.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$789.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$368.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.40
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$683.80
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: Riverside University Health System MISP |
$420.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$631.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$631.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$526.00
|
| Rate for Payer: United Healthcare All Other HMO |
$526.00
|
| Rate for Payer: United Healthcare HMO Rider |
$526.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$526.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.20
|
| Rate for Payer: Vantage Medical Group Senior |
$894.20
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
OP
|
$3,291.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,175.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,797.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,810.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,810.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,974.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$1,480.95
|
| Rate for Payer: Cash Price |
$1,480.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,632.80
|
| Rate for Payer: Cigna of CA PPO |
$2,435.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,797.35
|
| Rate for Payer: Dignity Health Media |
$2,797.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,797.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,316.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,316.40
|
| Rate for Payer: Galaxy Health WC |
$2,797.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,974.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,961.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,468.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,151.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,195.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.20
|
| Rate for Payer: Multiplan Commercial |
$2,468.25
|
| Rate for Payer: Networks By Design Commercial |
$2,139.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,797.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,316.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,974.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,974.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,797.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,797.35
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
IP
|
$4,968.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$993.60 |
| Max. Negotiated Rate |
$4,471.20 |
| Rate for Payer: Cash Price |
$2,235.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,974.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,987.20
|
| Rate for Payer: Galaxy Health WC |
$4,222.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,980.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,471.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,313.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,892.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.60
|
| Rate for Payer: Multiplan Commercial |
$3,726.00
|
| Rate for Payer: Networks By Design Commercial |
$3,229.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,222.80
|
|
|
HC ESOPHAGOSCOPY RIGID TRANSORAL
|
Facility
|
IP
|
$14,533.00
|
|
|
Service Code
|
CPT 43180
|
| Hospital Charge Code |
906743180
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,906.60 |
| Max. Negotiated Rate |
$13,079.70 |
| Rate for Payer: Cash Price |
$6,539.85
|
| Rate for Payer: Central Health Plan Commercial |
$11,626.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,813.20
|
| Rate for Payer: Galaxy Health WC |
$12,353.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,719.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,079.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,693.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,537.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,906.60
|
| Rate for Payer: Multiplan Commercial |
$10,899.75
|
| Rate for Payer: Networks By Design Commercial |
$9,446.45
|
| Rate for Payer: Prime Health Services Commercial |
$12,353.05
|
|
|
HC ESOPHAGOSCOPY RIGID TRANSORAL
|
Facility
|
OP
|
$14,533.00
|
|
|
Service Code
|
CPT 43180
|
| Hospital Charge Code |
906743180
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$923.12 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,719.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Cash Price |
$6,539.85
|
| Rate for Payer: Cash Price |
$6,539.85
|
| Rate for Payer: Central Health Plan Commercial |
$11,626.40
|
| Rate for Payer: Cigna of CA PPO |
$10,754.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Media |
$7,316.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Galaxy Health WC |
$12,353.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,719.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,079.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,899.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,072.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,316.90
|
| Rate for Payer: InnovAge PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,693.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,906.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan Commercial |
$10,899.75
|
| Rate for Payer: Networks By Design Commercial |
$9,446.45
|
| Rate for Payer: Prime Health Services Commercial |
$12,353.05
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Riverside University Health System MISP |
$8,048.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,719.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,780.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
HC ESOPHAGOSCOPY W BLLN LT 30MM
|
Facility
|
IP
|
$5,664.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
900501292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,132.80 |
| Max. Negotiated Rate |
$5,097.60 |
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,531.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,265.60
|
| Rate for Payer: Galaxy Health WC |
$4,814.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,398.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,097.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,777.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,157.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,132.80
|
| Rate for Payer: Multiplan Commercial |
$4,248.00
|
| Rate for Payer: Networks By Design Commercial |
$3,681.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,814.40
|
|
|
HC ESOPHAGOSCOPY W BLLN LT 30MM
|
Facility
|
OP
|
$5,664.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
900501292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,398.40
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,531.20
|
| Rate for Payer: Cigna of CA PPO |
$4,191.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$4,814.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,398.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,097.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,248.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: InnovAge PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,777.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,132.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$4,248.00
|
| Rate for Payer: Networks By Design Commercial |
$3,681.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,814.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,398.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,832.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,832.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,832.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPHAGOSCOPY W OPTICAL ENDOMI
|
Facility
|
OP
|
$2,527.00
|
|
|
Service Code
|
CPT 43206
|
| Hospital Charge Code |
906743206
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$505.40 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,516.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,137.15
|
| Rate for Payer: Cash Price |
$1,137.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,021.60
|
| Rate for Payer: Cigna of CA PPO |
$1,869.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,147.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,516.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,274.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,895.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,922.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: InnovAge PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,685.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$1,895.25
|
| Rate for Payer: Networks By Design Commercial |
$1,642.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,147.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,516.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPHAGOSCOPY W OPTICAL ENDOMI
|
Facility
|
IP
|
$3,781.00
|
|
|
Service Code
|
CPT 43206
|
| Hospital Charge Code |
906743206
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$756.20 |
| Max. Negotiated Rate |
$3,402.90 |
| Rate for Payer: Cash Price |
$1,701.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,024.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,512.40
|
| Rate for Payer: Galaxy Health WC |
$3,213.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,268.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,402.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,521.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,440.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.20
|
| Rate for Payer: Multiplan Commercial |
$2,835.75
|
| Rate for Payer: Networks By Design Commercial |
$2,457.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,213.85
|
|
|
HC ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
IP
|
$5,689.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,137.80 |
| Max. Negotiated Rate |
$5,120.10 |
| Rate for Payer: Cash Price |
$2,560.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,551.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,275.60
|
| Rate for Payer: Galaxy Health WC |
$4,835.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,413.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,120.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,794.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,167.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.80
|
| Rate for Payer: Multiplan Commercial |
$4,266.75
|
| Rate for Payer: Networks By Design Commercial |
$3,697.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,835.65
|
|
|
HC ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
OP
|
$3,802.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,281.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,041.60
|
| Rate for Payer: Cigna of CA PPO |
$2,813.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,231.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,281.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,421.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,851.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,535.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,851.50
|
| Rate for Payer: Networks By Design Commercial |
$2,471.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,231.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,281.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
IP
|
$5,689.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,137.80 |
| Max. Negotiated Rate |
$5,120.10 |
| Rate for Payer: Cash Price |
$2,560.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,551.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,275.60
|
| Rate for Payer: Galaxy Health WC |
$4,835.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,413.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,120.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,794.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,167.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.80
|
| Rate for Payer: Multiplan Commercial |
$4,266.75
|
| Rate for Payer: Networks By Design Commercial |
$3,697.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,835.65
|
|
|
HC ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
OP
|
$3,802.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$3,421.80 |
| 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 |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,281.20
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,041.60
|
| Rate for Payer: Cigna of CA PPO |
$2,813.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,231.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,281.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,421.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,851.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,535.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,851.50
|
| Rate for Payer: Networks By Design Commercial |
$2,471.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,231.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,281.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,901.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,901.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,901.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,901.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ESOPHAGUS CELLVIZIO
|
Facility
|
IP
|
$5,602.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,120.40 |
| Max. Negotiated Rate |
$5,041.80 |
| Rate for Payer: Cash Price |
$2,520.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,481.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,240.80
|
| Rate for Payer: Galaxy Health WC |
$4,761.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,361.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,041.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,736.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,134.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.40
|
| Rate for Payer: Multiplan Commercial |
$4,201.50
|
| Rate for Payer: Networks By Design Commercial |
$3,641.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,761.70
|
|
|
HC ESOPHAGUS CELLVIZIO
|
Facility
|
OP
|
$2,968.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$593.60 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,437.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,753.49
|
| Rate for Payer: Blue Distinction Transplant |
$1,780.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,374.40
|
| Rate for Payer: Cigna of CA PPO |
$2,196.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,522.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,780.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,671.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,226.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,979.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,226.00
|
| Rate for Payer: Networks By Design Commercial |
$1,929.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,522.80
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,780.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ESOPHAGUS ENDOSCOPY W RMVL FB
|
Facility
|
OP
|
$5,861.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
900501291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,274.90 |
| 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 |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,516.60
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,688.80
|
| Rate for Payer: Cigna of CA PPO |
$4,337.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$4,981.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,516.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,274.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,395.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: InnovAge PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,909.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$4,395.75
|
| Rate for Payer: Networks By Design Commercial |
$3,809.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,981.85
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,516.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,930.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,930.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,930.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,930.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPHAGUS ENDOSCOPY W RMVL FB
|
Facility
|
IP
|
$5,861.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
900501291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,172.20 |
| Max. Negotiated Rate |
$5,274.90 |
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,688.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,344.40
|
| Rate for Payer: Galaxy Health WC |
$4,981.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,516.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,274.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,909.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,233.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.20
|
| Rate for Payer: Multiplan Commercial |
$4,395.75
|
| Rate for Payer: Networks By Design Commercial |
$3,809.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,981.85
|
|
|
HC ESOPHAGUS ENDOSCOPY W/RMVL FB
|
Facility
|
OP
|
$5,861.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
902100066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,274.90 |
| 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 |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,516.60
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,688.80
|
| Rate for Payer: Cigna of CA PPO |
$4,337.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$4,981.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,516.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,274.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,395.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: InnovAge PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,909.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$4,395.75
|
| Rate for Payer: Networks By Design Commercial |
$3,809.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,981.85
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,516.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,930.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,930.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,930.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,930.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPHAGUS ENDOSCOPY W/RMVL FB
|
Facility
|
IP
|
$5,861.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
902100066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,172.20 |
| Max. Negotiated Rate |
$5,274.90 |
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,688.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,344.40
|
| Rate for Payer: Galaxy Health WC |
$4,981.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,516.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,274.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,909.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,233.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.20
|
| Rate for Payer: Multiplan Commercial |
$4,395.75
|
| Rate for Payer: Networks By Design Commercial |
$3,809.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,981.85
|
|
|
HC ESOPH BLLN DISTENSION PROVOCAT
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
CPT 91040
|
| Hospital Charge Code |
906791040
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$145.80 |
| Max. Negotiated Rate |
$656.10 |
| Rate for Payer: Cash Price |
$328.05
|
| Rate for Payer: Central Health Plan Commercial |
$583.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.60
|
| Rate for Payer: Galaxy Health WC |
$619.65
|
| Rate for Payer: Global Benefits Group Commercial |
$437.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$656.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$277.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.80
|
| Rate for Payer: Multiplan Commercial |
$546.75
|
| Rate for Payer: Networks By Design Commercial |
$473.85
|
| Rate for Payer: Prime Health Services Commercial |
$619.65
|
|
|
HC ESOPH BLLN DISTENSION PROVOCAT
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
CPT 91040
|
| Hospital Charge Code |
906791040
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$669.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,781.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,082.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.09
|
| Rate for Payer: Blue Distinction Transplant |
$241.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$669.68
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Central Health Plan Commercial |
$322.40
|
| Rate for Payer: Cigna of CA PPO |
$298.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$362.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$302.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,104.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: InnovAge PACE Commercial |
$1,004.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$897.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Medicare |
$709.86
|
| Rate for Payer: Riverside University Health System MISP |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC ESOPH DIAG DILATION
|
Facility
|
OP
|
$3,785.00
|
|
|
Service Code
|
CPT 43226
|
| Hospital Charge Code |
906743226
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,271.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,028.00
|
| Rate for Payer: Cigna of CA PPO |
$2,800.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,217.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,271.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,406.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,838.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,922.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: InnovAge PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,524.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$757.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$2,838.75
|
| Rate for Payer: Networks By Design Commercial |
$2,460.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,217.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,271.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH DIAG DILATION
|
Facility
|
IP
|
$7,081.00
|
|
|
Service Code
|
CPT 43226
|
| Hospital Charge Code |
906743226
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,416.20 |
| Max. Negotiated Rate |
$6,372.90 |
| Rate for Payer: Cash Price |
$3,186.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,664.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,832.40
|
| Rate for Payer: Galaxy Health WC |
$6,018.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,248.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,372.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,723.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,697.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.20
|
| Rate for Payer: Multiplan Commercial |
$5,310.75
|
| Rate for Payer: Networks By Design Commercial |
$4,602.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,018.85
|
|
|
HC ESOPH DIAG FLEX TRANSNASAL
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 43197
|
| Hospital Charge Code |
906743197
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$131.58 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,108.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$831.15
|
| Rate for Payer: Cash Price |
$831.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,477.60
|
| Rate for Payer: Cigna of CA PPO |
$1,366.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$1,569.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,108.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,662.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,385.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,231.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$369.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,385.25
|
| Rate for Payer: Networks By Design Commercial |
$1,200.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,569.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,108.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ESOPH DIAG FLEX TRANSNASAL
|
Facility
|
IP
|
$3,456.00
|
|
|
Service Code
|
CPT 43197
|
| Hospital Charge Code |
906743197
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$691.20 |
| Max. Negotiated Rate |
$3,110.40 |
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,764.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.40
|
| Rate for Payer: Galaxy Health WC |
$2,937.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,073.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,305.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,316.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.20
|
| Rate for Payer: Multiplan Commercial |
$2,592.00
|
| Rate for Payer: Networks By Design Commercial |
$2,246.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,937.60
|
|
