|
HC ESOPH DIAG W/BAND LIGATION
|
Facility
|
OP
|
$3,566.00
|
|
|
Service Code
|
CPT 43205
|
| Hospital Charge Code |
906743205
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| Rate for Payer: Adventist Health Commercial |
$430.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,328.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,203.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,397.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,317.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,207.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,330.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,025.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,700.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$645.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,674.50
|
| Rate for Payer: Multiplan Commercial |
$1,612.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH DIAG W/BLLN DILATION
|
Facility
|
OP
|
$3,352.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
906743220
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$670.40
|
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,889.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,071.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,987.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,178.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,074.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,892.28
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,458.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,598.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$606.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,514.00
|
| Rate for Payer: Multiplan Commercial |
$2,292.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH DIAG W/BLLN DILATION
|
Facility
|
IP
|
$3,352.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
906743220
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$2,514.00 |
| Rate for Payer: Adventist Health Commercial |
$670.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,158.69
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,269.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,269.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$606.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.00
|
| Rate for Payer: Multiplan Commercial |
$2,514.00
|
|
|
HC ESOPH DIAG W/BX SNGL OR MULTI
|
Facility
|
OP
|
$3,163.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
906743202
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$632.60
|
| Rate for Payer: Adventist Health Commercial |
$265.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$818.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,954.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$861.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,055.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,957.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$820.17
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$632.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,508.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$572.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$790.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,372.25
|
| Rate for Payer: Multiplan Commercial |
$993.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH DIAG W/BX SNGL OR MULTI
|
Facility
|
IP
|
$1,325.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
906743202
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$239.82 |
| Max. Negotiated Rate |
$993.75 |
| Rate for Payer: Adventist Health Commercial |
$265.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$853.30
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$897.02
|
| Rate for Payer: Heritage Provider Network Senior |
$897.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.25
|
| Rate for Payer: Multiplan Commercial |
$993.75
|
|
|
HC ESOPH DIAG W/ENDO US
|
Facility
|
OP
|
$4,933.00
|
|
|
Service Code
|
CPT 43232
|
| Hospital Charge Code |
906743232
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$986.60
|
| Rate for Payer: Adventist Health Commercial |
$899.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,779.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,048.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,219.85
|
| Rate for Payer: Cash Price |
$2,219.85
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Cash Price |
$2,219.85
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,923.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,206.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,053.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,784.26
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,145.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,353.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$892.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$814.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,124.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,233.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,699.75
|
| Rate for Payer: Multiplan Commercial |
$3,373.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH DIAG W/ENDO US
|
Facility
|
IP
|
$4,933.00
|
|
|
Service Code
|
CPT 43232
|
| Hospital Charge Code |
906743232
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$892.87 |
| Max. Negotiated Rate |
$3,699.75 |
| Rate for Payer: Adventist Health Commercial |
$986.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,176.85
|
| Rate for Payer: Cash Price |
$2,219.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,339.64
|
| Rate for Payer: Heritage Provider Network Senior |
$3,339.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$892.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,233.25
|
| Rate for Payer: Multiplan Commercial |
$3,699.75
|
|
|
HC ESOPH DIAG W/ENDO US EXAM
|
Facility
|
IP
|
$4,923.00
|
|
|
Service Code
|
CPT 43231
|
| Hospital Charge Code |
906743231
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$891.06 |
| Max. Negotiated Rate |
$3,692.25 |
| Rate for Payer: Adventist Health Commercial |
$984.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,170.41
|
| Rate for Payer: Cash Price |
$2,215.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,332.87
|
| Rate for Payer: Heritage Provider Network Senior |
$3,332.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$891.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,230.75
|
| Rate for Payer: Multiplan Commercial |
$3,692.25
|
|
|
HC ESOPH DIAG W/ENDO US EXAM
|
Facility
|
OP
|
$4,923.00
|
|
|
Service Code
|
CPT 43231
|
| Hospital Charge Code |
906743231
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$984.60
|
| Rate for Payer: Adventist Health Commercial |
$897.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,774.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,042.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,215.35
|
| Rate for Payer: Cash Price |
$2,215.35
|
| Rate for Payer: Cash Price |
$2,020.05
|
| Rate for Payer: Cash Price |
$2,020.05
|
| Rate for Payer: Cash Price |
$2,215.35
|
| Rate for Payer: Cash Price |
$2,020.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,917.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,199.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,047.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,778.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,141.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,348.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$891.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$812.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,230.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,692.25
|
| Rate for Payer: Multiplan Commercial |
$3,366.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH DIAG W/LESION
|
Facility
|
IP
|
$3,967.00
|
|
|
Service Code
|
CPT 43216
|
| Hospital Charge Code |
906743216
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$718.03 |
| Max. Negotiated Rate |
$2,975.25 |
| Rate for Payer: Adventist Health Commercial |
$793.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,554.75
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,685.66
|
| Rate for Payer: Heritage Provider Network Senior |
$2,685.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$718.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.75
|
| Rate for Payer: Multiplan Commercial |
$2,975.25
|
|
|
HC ESOPH DIAG W/LESION
|
Facility
|
OP
|
$3,967.00
|
|
|
Service Code
|
CPT 43216
|
| Hospital Charge Code |
906743216
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$793.40
|
| Rate for Payer: Adventist Health Commercial |
$632.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,954.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,451.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,055.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,578.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,455.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,957.90
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,508.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,892.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$718.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$572.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$790.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,975.25
|
| Rate for Payer: Multiplan Commercial |
$2,372.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH DIAG W/RMVL OF FB
|
Facility
|
OP
|
$3,163.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
906743215
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$632.60
|
| Rate for Payer: Adventist Health Commercial |
$430.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,328.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,954.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,397.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,055.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,957.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,330.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,025.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,508.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$572.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$790.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,372.25
|
| Rate for Payer: Multiplan Commercial |
$1,612.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH DIAG W/RMVL OF FB
|
Facility
|
IP
|
$2,150.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
906743215
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$389.15 |
| Max. Negotiated Rate |
$1,612.50 |
| Rate for Payer: Adventist Health Commercial |
$430.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,384.60
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,455.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,455.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.50
|
| Rate for Payer: Multiplan Commercial |
$1,612.50
|
|
|
HC ESOPH DIAG W/SCLEROSIS
|
Facility
|
IP
|
$1,325.00
|
|
|
Service Code
|
CPT 43204
|
| Hospital Charge Code |
906743204
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$239.82 |
| Max. Negotiated Rate |
$993.75 |
| Rate for Payer: Adventist Health Commercial |
$265.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$853.30
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$897.02
|
| Rate for Payer: Heritage Provider Network Senior |
$897.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.25
|
| Rate for Payer: Multiplan Commercial |
$993.75
|
|
|
HC ESOPH DIAG W/SCLEROSIS
|
Facility
|
OP
|
$3,566.00
|
|
|
Service Code
|
CPT 43204
|
| Hospital Charge Code |
906743204
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| Rate for Payer: Adventist Health Commercial |
$265.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$818.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,203.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$861.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,317.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,207.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$820.17
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$632.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,700.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$645.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,674.50
|
| Rate for Payer: Multiplan Commercial |
$993.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH DIAG W/SNARE
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 43217
|
| Hospital Charge Code |
906743217
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$356.39 |
| Max. Negotiated Rate |
$1,476.75 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,268.04
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,333.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$356.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.25
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
|
|
HC ESOPH DIAG W/SNARE
|
Facility
|
OP
|
$3,566.00
|
|
|
Service Code
|
CPT 43217
|
| Hospital Charge Code |
906743217
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,216.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,203.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,279.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,317.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,207.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,218.81
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$939.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,700.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$645.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$356.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,674.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH DIAG W/SUBMUC INJ
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
CPT 43201
|
| Hospital Charge Code |
906743201
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$612.00
|
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,216.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,891.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,279.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,989.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,894.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,218.81
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$939.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,459.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$356.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$765.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH DIAG W/SUBMUC INJ
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 43201
|
| Hospital Charge Code |
906743201
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$356.39 |
| Max. Negotiated Rate |
$1,476.75 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,268.04
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,333.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$356.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.25
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
|
|
HC ESOPH ENDOSCOPY REP
|
Facility
|
OP
|
$3,057.00
|
|
|
Service Code
|
CPT 43227
|
| Hospital Charge Code |
906743227
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Adventist Health Commercial |
$395.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,222.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,889.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$890.10
|
| Rate for Payer: Cash Price |
$890.10
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$890.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,285.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,987.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,892.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,224.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$943.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,458.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$358.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,292.75
|
| Rate for Payer: Multiplan Commercial |
$1,483.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH ENDOSCOPY REP
|
Facility
|
IP
|
$1,978.00
|
|
|
Service Code
|
CPT 43227
|
| Hospital Charge Code |
906743227
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$358.02 |
| Max. Negotiated Rate |
$1,483.50 |
| Rate for Payer: Adventist Health Commercial |
$395.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,273.83
|
| Rate for Payer: Cash Price |
$890.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,339.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1,339.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$358.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.50
|
| Rate for Payer: Multiplan Commercial |
$1,483.50
|
|
|
HC ESOPH IMPED FUNC TST GT 1HR-24HR
|
Facility
|
OP
|
$1,809.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
906791037
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$277.71 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$361.80
|
| Rate for Payer: Adventist Health Commercial |
$285.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,117.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$882.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$714.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$904.86
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$814.05
|
| Rate for Payer: Cash Price |
$814.05
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$814.05
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$928.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,175.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$856.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,085.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,119.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$883.93
|
| Rate for Payer: Heritage Provider Network Senior |
$341.58
|
| Rate for Payer: Heritage Provider Network Senior |
$341.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$681.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$862.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$327.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$258.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$1,356.75
|
| Rate for Payer: Multiplan Commercial |
$1,071.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC ESOPH IMPED FUNC TST GT 1HR-24HR
|
Facility
|
IP
|
$1,809.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
906791037
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$327.43 |
| Max. Negotiated Rate |
$1,356.75 |
| Rate for Payer: Adventist Health Commercial |
$361.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,165.00
|
| Rate for Payer: Cash Price |
$814.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,224.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,224.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$327.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.25
|
| Rate for Payer: Multiplan Commercial |
$1,356.75
|
|
|
HC ESOPH IMPED FUNC TST UP TO 1HR
|
Facility
|
IP
|
$966.00
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
906791038
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$174.85 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$622.10
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$653.98
|
| Rate for Payer: Heritage Provider Network Senior |
$653.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.50
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
|
|
HC ESOPH IMPED FUNC TST UP TO 1HR
|
Facility
|
OP
|
$966.00
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
906791038
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$174.85 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Adventist Health Commercial |
$285.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$596.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$882.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$714.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$483.19
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$928.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$627.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$856.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$479.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$479.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$597.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$883.93
|
| Rate for Payer: Heritage Provider Network Senior |
$590.33
|
| Rate for Payer: Heritage Provider Network Senior |
$590.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$681.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$460.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$258.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$551.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$551.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
| Rate for Payer: Multiplan Commercial |
$1,071.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
