|
HC ESOPH DIAG W/BX SNGL OR MULTI
|
Facility
|
IP
|
$5,861.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
906743202
|
|
Hospital Revenue Code
|
750
|
| 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 DIAG W/ENDO US
|
Facility
|
OP
|
$5,570.00
|
|
|
Service Code
|
CPT 43232
|
| Hospital Charge Code |
906743232
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$439.28 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,342.00
|
| 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 |
$2,506.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,456.00
|
| Rate for Payer: Cigna of CA PPO |
$4,121.80
|
| 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 |
$4,734.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,013.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,177.50
|
| 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 |
$3,715.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.00
|
| 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 |
$4,177.50
|
| Rate for Payer: Networks By Design Commercial |
$3,620.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,734.50
|
| 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 |
$3,342.00
|
| 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 W/ENDO US
|
Facility
|
IP
|
$8,334.00
|
|
|
Service Code
|
CPT 43232
|
| Hospital Charge Code |
906743232
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,666.80 |
| Max. Negotiated Rate |
$7,500.60 |
| Rate for Payer: Cash Price |
$3,750.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,667.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,333.60
|
| Rate for Payer: Galaxy Health WC |
$7,083.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,000.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,558.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,175.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,666.80
|
| Rate for Payer: Multiplan Commercial |
$6,250.50
|
| Rate for Payer: Networks By Design Commercial |
$5,417.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,083.90
|
|
|
HC ESOPH DIAG W/ENDO US EXAM
|
Facility
|
IP
|
$9,632.00
|
|
|
Service Code
|
CPT 43231
|
| Hospital Charge Code |
906743231
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,926.40 |
| Max. Negotiated Rate |
$8,668.80 |
| Rate for Payer: Cash Price |
$4,334.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,705.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,852.80
|
| Rate for Payer: Galaxy Health WC |
$8,187.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,779.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,668.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,424.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,669.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,926.40
|
| Rate for Payer: Multiplan Commercial |
$7,224.00
|
| Rate for Payer: Networks By Design Commercial |
$6,260.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,187.20
|
|
|
HC ESOPH DIAG W/ENDO US EXAM
|
Facility
|
OP
|
$5,559.00
|
|
|
Service Code
|
CPT 43231
|
| Hospital Charge Code |
906743231
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$377.74 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,335.40
|
| 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 |
$2,501.55
|
| Rate for Payer: Cash Price |
$2,501.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,447.20
|
| Rate for Payer: Cigna of CA PPO |
$4,113.66
|
| 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 |
$4,725.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,335.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,003.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,169.25
|
| 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 |
$3,707.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,111.80
|
| 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 |
$4,169.25
|
| Rate for Payer: Networks By Design Commercial |
$3,613.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,725.15
|
| 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 |
$3,335.40
|
| 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 W/LESION
|
Facility
|
IP
|
$5,861.00
|
|
|
Service Code
|
CPT 43216
|
| Hospital Charge Code |
906743216
|
|
Hospital Revenue Code
|
750
|
| 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 DIAG W/LESION
|
Facility
|
OP
|
$3,917.00
|
|
|
Service Code
|
CPT 43216
|
| Hospital Charge Code |
906743216
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$376.31 |
| Max. Negotiated Rate |
$15,354.00 |
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,350.20
|
| 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 |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,762.65
|
| Rate for Payer: Cash Price |
$1,762.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,133.60
|
| Rate for Payer: Cigna of CA PPO |
$2,898.58
|
| 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 |
$3,329.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,350.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,525.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,937.75
|
| 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 |
$2,612.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.40
|
| 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 |
$2,937.75
|
| Rate for Payer: Networks By Design Commercial |
$2,546.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,329.45
|
| 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 |
$2,350.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| 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 |
$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 W/RMVL OF FB
|
Facility
|
IP
|
$5,861.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
906743215
|
|
Hospital Revenue Code
|
750
|
| 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 DIAG W/RMVL OF FB
|
Facility
|
OP
|
$3,917.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
906743215
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$424.42 |
| 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 |
$2,350.20
|
| 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 |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,762.65
|
| Rate for Payer: Cash Price |
$1,762.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,133.60
|
| Rate for Payer: Cigna of CA PPO |
$2,898.58
|
| 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 |
$3,329.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,350.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,525.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,937.75
|
| 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 |
$2,612.64
|
| 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 |
$783.40
|
| 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 |
$2,937.75
|
| Rate for Payer: Networks By Design Commercial |
$2,546.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,329.45
|
| 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 |
$2,350.20
|
| 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 ESOPH DIAG W/SCLEROSIS
|
Facility
|
IP
|
$6,608.00
|
|
|
Service Code
|
CPT 43204
|
| Hospital Charge Code |
906743204
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,321.60 |
| Max. Negotiated Rate |
$5,947.20 |
| Rate for Payer: Cash Price |
$2,973.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,286.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Galaxy Health WC |
$5,616.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,947.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,517.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,321.60
|
| Rate for Payer: Multiplan Commercial |
$4,956.00
|
| Rate for Payer: Networks By Design Commercial |
$4,295.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,616.80
|
|
|
HC ESOPH DIAG W/SCLEROSIS
|
Facility
|
OP
|
$4,416.00
|
|
|
Service Code
|
CPT 43204
|
| Hospital Charge Code |
906743204
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$530.54 |
| 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 |
$2,649.60
|
| 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: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,532.80
|
| Rate for Payer: Cigna of CA PPO |
$3,267.84
|
| 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 |
$3,753.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,649.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,974.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,312.00
|
| 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 |
$2,945.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$883.20
|
| 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 |
$3,312.00
|
| Rate for Payer: Networks By Design Commercial |
$2,870.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,753.60
|
| 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 |
$2,649.60
|
| 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 W/SNARE
|
Facility
|
OP
|
$4,416.00
|
|
|
Service Code
|
CPT 43217
|
| Hospital Charge Code |
906743217
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$270.22 |
| 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 |
$2,649.60
|
| 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: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,532.80
|
| Rate for Payer: Cigna of CA PPO |
$3,267.84
|
| 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 |
$3,753.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,649.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,974.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,312.00
|
| 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 |
$2,945.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$883.20
|
| 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 |
$3,312.00
|
| Rate for Payer: Networks By Design Commercial |
$2,870.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,753.60
|
| 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 |
$2,649.60
|
| 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 W/SNARE
|
Facility
|
IP
|
$6,608.00
|
|
|
Service Code
|
CPT 43217
|
| Hospital Charge Code |
906743217
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,321.60 |
| Max. Negotiated Rate |
$5,947.20 |
| Rate for Payer: Cash Price |
$2,973.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,286.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Galaxy Health WC |
$5,616.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,947.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,517.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,321.60
|
| Rate for Payer: Multiplan Commercial |
$4,956.00
|
| Rate for Payer: Networks By Design Commercial |
$4,295.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,616.80
|
|
|
HC ESOPH DIAG W/SUBMUC INJ
|
Facility
|
OP
|
$3,790.00
|
|
|
Service Code
|
CPT 43201
|
| Hospital Charge Code |
906743201
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$397.90 |
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,274.00
|
| 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 |
$1,705.50
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,032.00
|
| Rate for Payer: Cigna of CA PPO |
$2,804.60
|
| 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 |
$3,221.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,274.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,411.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,842.50
|
| 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 |
$2,527.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.00
|
| 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 |
$2,842.50
|
| Rate for Payer: Networks By Design Commercial |
$2,463.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,221.50
|
| 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 |
$2,274.00
|
| 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 W/SUBMUC INJ
|
Facility
|
IP
|
$7,089.00
|
|
|
Service Code
|
CPT 43201
|
| Hospital Charge Code |
906743201
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,417.80 |
| Max. Negotiated Rate |
$6,380.10 |
| Rate for Payer: Cash Price |
$3,190.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,671.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,835.60
|
| Rate for Payer: Galaxy Health WC |
$6,025.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,253.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,380.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,728.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,700.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,417.80
|
| Rate for Payer: Multiplan Commercial |
$5,316.75
|
| Rate for Payer: Networks By Design Commercial |
$4,607.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,025.65
|
|
|
HC ESOPH ENDOSCOPY REP
|
Facility
|
OP
|
$3,785.00
|
|
|
Service Code
|
CPT 43227
|
| Hospital Charge Code |
906743227
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$327.50 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,271.00
|
| 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 |
$1,703.25
|
| 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 |
$327.50
|
| 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 ENDOSCOPY REP
|
Facility
|
IP
|
$5,664.00
|
|
|
Service Code
|
CPT 43227
|
| Hospital Charge Code |
906743227
|
|
Hospital Revenue Code
|
750
|
| 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 ESOPH IMPED FUNC TST GT 1HR-24HR
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
906791037
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$670.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$707.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$638.06
|
| Rate for Payer: Blue Distinction Transplant |
$648.00
|
| 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 |
$392.17
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Central Health Plan Commercial |
$864.00
|
| Rate for Payer: Cigna of CA PPO |
$799.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$810.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$810.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$648.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.60
|
| 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 |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC ESOPH IMPED FUNC TST GT 1HR-24HR
|
Facility
|
IP
|
$2,443.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
906791037
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$488.60 |
| Max. Negotiated Rate |
$2,198.70 |
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$977.20
|
| Rate for Payer: Galaxy Health WC |
$2,076.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,465.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,198.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,629.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$930.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$1,832.25
|
| Rate for Payer: Networks By Design Commercial |
$1,587.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,076.55
|
|
|
HC ESOPH IMPED FUNC TST UP TO 1HR
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
906791038
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$669.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,456.55
|
| 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 |
$490.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$638.06
|
| Rate for Payer: Blue Distinction Transplant |
$648.00
|
| 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 |
$486.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Central Health Plan Commercial |
$864.00
|
| Rate for Payer: Cigna of CA PPO |
$799.20
|
| 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 |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$810.00
|
| 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 |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| 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 |
$810.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
| 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 |
$648.00
|
| 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 IMPED FUNC TST UP TO 1HR
|
Facility
|
IP
|
$2,443.00
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
906791038
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$488.60 |
| Max. Negotiated Rate |
$2,198.70 |
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$977.20
|
| Rate for Payer: Galaxy Health WC |
$2,076.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,465.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,198.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,629.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$930.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$1,832.25
|
| Rate for Payer: Networks By Design Commercial |
$1,587.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,076.55
|
|
|
HC ESOPH LESION ABLATION
|
Facility
|
OP
|
$5,790.00
|
|
|
Service Code
|
CPT 43229
|
| Hospital Charge Code |
900100016
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$340.25 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,785.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| 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 |
$3,474.00
|
| 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 |
$4,785.03
|
| Rate for Payer: Cash Price |
$2,605.50
|
| Rate for Payer: Cash Price |
$2,605.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,632.00
|
| Rate for Payer: Cigna of CA PPO |
$4,284.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Media |
$4,785.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,459.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,785.03
|
| Rate for Payer: Galaxy Health WC |
$4,921.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,474.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,211.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,342.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,847.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,895.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,785.03
|
| Rate for Payer: InnovAge PACE Commercial |
$7,177.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,861.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,785.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,158.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,411.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,411.94
|
| Rate for Payer: Multiplan Commercial |
$4,342.50
|
| Rate for Payer: Networks By Design Commercial |
$3,763.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,921.50
|
| Rate for Payer: Prime Health Services Medicare |
$5,072.13
|
| Rate for Payer: Riverside University Health System MISP |
$5,263.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,474.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,742.04
|
| 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 |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
HC ESOPH LESION ABLATION
|
Facility
|
IP
|
$8,949.00
|
|
|
Service Code
|
CPT 43229
|
| Hospital Charge Code |
900100016
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,789.80 |
| Max. Negotiated Rate |
$8,054.10 |
| Rate for Payer: Cash Price |
$4,027.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,159.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,579.60
|
| Rate for Payer: Galaxy Health WC |
$7,606.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,369.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,054.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,968.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,409.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,789.80
|
| Rate for Payer: Multiplan Commercial |
$6,711.75
|
| Rate for Payer: Networks By Design Commercial |
$5,816.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,606.65
|
|
|
HC ESOPH MOTILITY STUDY W/MECH/SI
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT 91013
|
| Hospital Charge Code |
906791011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$320.40 |
| Max. Negotiated Rate |
$1,441.80 |
| Rate for Payer: Cash Price |
$720.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,281.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.80
|
| Rate for Payer: Galaxy Health WC |
$1,361.70
|
| Rate for Payer: Global Benefits Group Commercial |
$961.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,441.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,068.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$610.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.40
|
| Rate for Payer: Multiplan Commercial |
$1,201.50
|
| Rate for Payer: Networks By Design Commercial |
$1,041.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,361.70
|
|
|
HC ESOPH MOTILITY STUDY W/MECH/SI
|
Facility
|
OP
|
$1,212.00
|
|
|
Service Code
|
CPT 91013
|
| Hospital Charge Code |
906791011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$39.41 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$79.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,030.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$666.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$666.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$716.05
|
| Rate for Payer: Blue Distinction Transplant |
$727.20
|
| 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: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Central Health Plan Commercial |
$969.60
|
| Rate for Payer: Cigna of CA PPO |
$896.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,030.20
|
| Rate for Payer: Dignity Health Media |
$1,030.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,030.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$484.80
|
| Rate for Payer: Galaxy Health WC |
$1,030.20
|
| Rate for Payer: Global Benefits Group Commercial |
$727.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,090.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$909.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$424.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$808.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.40
|
| Rate for Payer: Multiplan Commercial |
$909.00
|
| Rate for Payer: Networks By Design Commercial |
$787.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,030.20
|
| Rate for Payer: Riverside University Health System MISP |
$484.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$727.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$727.20
|
| 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 Medi-Cal |
$1,030.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,030.20
|
|
