|
HC ERCP W/SPHINCTERTMY
|
Facility
|
OP
|
$4,460.00
|
|
|
Service Code
|
CPT 43262
|
| Hospital Charge Code |
906743262
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,064.02
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,899.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: Dignity Health Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,785.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,760.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5,885.59
|
| Rate for Payer: Humana Medicare |
$4,785.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$577.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,091.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,646.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,115.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,029.14
|
| Rate for Payer: Multiplan Commercial |
$3,345.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| 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 ERCP W/SPHINCTERTMY
|
Facility
|
IP
|
$5,570.00
|
|
|
Service Code
|
CPT 43262
|
| Hospital Charge Code |
906743262
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,008.17 |
| Max. Negotiated Rate |
$4,177.50 |
| Rate for Payer: Adventist Health Commercial |
$1,114.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,826.59
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,770.89
|
| Rate for Payer: Heritage Provider Network Senior |
$3,770.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,008.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,392.50
|
| Rate for Payer: Multiplan Commercial |
$4,177.50
|
|
|
HC ESBL DISK CONFIRMATION
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.70
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.56
|
| Rate for Payer: Heritage Provider Network Senior |
$145.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
|
|
HC ESBL DISK CONFIRMATION
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$57.65 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.65
|
| Rate for Payer: Blue Shield of California Commercial |
$53.83
|
| Rate for Payer: Blue Shield of California EPN |
$42.08
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Senior |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Humana Medicare |
$7.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.42
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$121.07 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$315.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$352.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,084.09
|
| 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: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,025.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: Dignity Health Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$946.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$669.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$976.78
|
| Rate for Payer: Heritage Provider Network Senior |
$823.71
|
| Rate for Payer: Humana Medicare |
$669.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,272.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$790.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$843.80
|
| Rate for Payer: Multiplan Commercial |
$1,183.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| 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 ACID REFLX TEST
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$176.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.31
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$598.47
|
| Rate for Payer: Heritage Provider Network Senior |
$598.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$663.00
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
OP
|
$3,785.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$278.77 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$757.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,600.30
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,460.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,342.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$278.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$2,838.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,615.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,615.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| 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 ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
IP
|
$5,664.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,025.18 |
| Max. Negotiated Rate |
$4,248.00 |
| Rate for Payer: Adventist Health Commercial |
$1,132.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,891.17
|
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,834.53
|
| Rate for Payer: Heritage Provider Network Senior |
$3,834.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,025.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.00
|
| Rate for Payer: Multiplan Commercial |
$4,248.00
|
|
|
HC ESOPHAGEAL DILATATION
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.65 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Adventist Health Commercial |
$330.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,133.55
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,117.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,117.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.50
|
| Rate for Payer: Multiplan Commercial |
$1,237.50
|
|
|
HC ESOPHAGEAL DILATATION
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.01 |
| Max. Negotiated Rate |
$1,402.50 |
| Rate for Payer: Adventist Health Commercial |
$330.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$200.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,133.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,402.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$907.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,237.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$750.09
|
| Rate for Payer: Blue Shield of California Commercial |
$645.50
|
| Rate for Payer: Blue Shield of California EPN |
$367.08
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,072.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,402.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,402.50
|
| Rate for Payer: Dignity Health Senior |
$1,402.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,072.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,021.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,021.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$170.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$795.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.50
|
| Rate for Payer: Multiplan Commercial |
$1,237.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,402.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,402.50
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
IP
|
$5,760.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,042.56 |
| Max. Negotiated Rate |
$4,320.00 |
| Rate for Payer: Adventist Health Commercial |
$1,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,957.12
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.52
|
| Rate for Payer: Heritage Provider Network Senior |
$3,899.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,042.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,440.00
|
| Rate for Payer: Multiplan Commercial |
$4,320.00
|
|
|
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 |
$143.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$658.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$466.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,260.92
|
| 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 |
$2,468.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,480.95
|
| Rate for Payer: Cash Price |
$1,480.95
|
| Rate for Payer: Cash Price |
$1,480.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,139.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,797.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,797.35
|
| Rate for Payer: Dignity Health Senior |
$2,797.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,037.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,037.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,586.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$822.75
|
| Rate for Payer: Multiplan Commercial |
$2,468.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,797.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,797.35
|
|
|
HC ESOPHAGOSCOPY RIGID TRANSORAL
|
Facility
|
OP
|
$14,533.00
|
|
|
Service Code
|
CPT 43180
|
| Hospital Charge Code |
906743180
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$13,902.11 |
| Rate for Payer: Adventist Health Commercial |
$2,906.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,984.17
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$6,539.85
|
| Rate for Payer: Cash Price |
$6,539.85
|
| Rate for Payer: Cash Price |
$6,539.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,446.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: Dignity Health Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,995.93
|
| Rate for Payer: Heritage Provider Network Senior |
$8,999.79
|
| Rate for Payer: Humana Medicare |
$7,316.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$757.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,902.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,630.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,633.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,633.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,219.29
|
| Rate for Payer: Multiplan Commercial |
$10,899.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| 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 RIGID TRANSORAL
|
Facility
|
IP
|
$14,533.00
|
|
|
Service Code
|
CPT 43180
|
| Hospital Charge Code |
906743180
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,630.47 |
| Max. Negotiated Rate |
$10,899.75 |
| Rate for Payer: Adventist Health Commercial |
$2,906.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,984.17
|
| Rate for Payer: Cash Price |
$6,539.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,838.84
|
| Rate for Payer: Heritage Provider Network Senior |
$9,838.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,630.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,633.25
|
| Rate for Payer: Multiplan Commercial |
$10,899.75
|
|
|
HC ESOPHAGOSCOPY W BLLN LT 30MM
|
Facility
|
OP
|
$4,152.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
900501292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$751.51 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$830.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,852.42
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,698.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,810.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,810.90
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| 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: Kaiser Permanente of CA Commercial |
$2,001.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$751.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,038.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$3,114.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,507.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,387.18
|
| 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 BLLN LT 30MM
|
Facility
|
IP
|
$4,152.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
900501292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$751.51 |
| Max. Negotiated Rate |
$3,114.00 |
| Rate for Payer: Adventist Health Commercial |
$830.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,852.42
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,810.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,810.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$751.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,038.00
|
| Rate for Payer: Multiplan Commercial |
$3,114.00
|
|
|
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 |
$684.36 |
| Max. Negotiated Rate |
$2,835.75 |
| Rate for Payer: Adventist Health Commercial |
$756.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,597.55
|
| Rate for Payer: Cash Price |
$1,701.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,559.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,559.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$684.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.25
|
| Rate for Payer: Multiplan Commercial |
$2,835.75
|
|
|
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 |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$505.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,736.05
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,137.15
|
| Rate for Payer: Cash Price |
$1,137.15
|
| Rate for Payer: Cash Price |
$1,137.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,642.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,564.21
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$631.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$1,895.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| 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/WO SPECIMEN
|
Facility
|
IP
|
$4,170.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$754.77 |
| Max. Negotiated Rate |
$3,127.50 |
| Rate for Payer: Adventist Health Commercial |
$834.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,864.79
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,823.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2,823.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.50
|
| Rate for Payer: Multiplan Commercial |
$3,127.50
|
|
|
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 |
$263.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$760.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,611.97
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| 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: Cigna of CA HMO/PPO |
$2,471.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,353.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$263.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$688.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$2,851.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| 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
|
OP
|
$3,802.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$688.16 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$760.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,611.97
|
| 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 HMO/PPO |
$3,237.00
|
| 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: Cigna of CA HMO/PPO |
$2,471.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,573.95
|
| Rate for Payer: Heritage Provider Network Senior |
$2,573.95
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| 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: Kaiser Permanente of CA Commercial |
$1,832.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$688.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$2,851.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,380.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,270.25
|
| 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
|
$4,170.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$754.77 |
| Max. Negotiated Rate |
$3,127.50 |
| Rate for Payer: Adventist Health Commercial |
$834.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,864.79
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,823.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2,823.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.50
|
| Rate for Payer: Multiplan Commercial |
$3,127.50
|
|
|
HC ESOPHAGUS CELLVIZIO
|
Facility
|
OP
|
$2,968.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$593.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,039.02
|
| 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: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,929.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,837.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$537.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$2,226.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| 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
|
$4,330.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$783.73 |
| Max. Negotiated Rate |
$3,247.50 |
| Rate for Payer: Adventist Health Commercial |
$866.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,974.71
|
| Rate for Payer: Cash Price |
$1,948.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,931.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,931.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$783.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.50
|
| Rate for Payer: Multiplan Commercial |
$3,247.50
|
|
|
HC ESOPHAGUS ENDOSCOPY W RMVL FB
|
Facility
|
OP
|
$2,663.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
900501291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$482.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$532.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,829.48
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,198.35
|
| Rate for Payer: Cash Price |
$1,198.35
|
| Rate for Payer: Cash Price |
$1,198.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,730.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,802.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,802.85
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| 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: Kaiser Permanente of CA Commercial |
$1,283.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$482.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$1,997.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$966.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$889.71
|
| 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
|
|
