|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
909300075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.56
|
| Rate for Payer: Blue Distinction Transplant |
$34.80
|
| Rate for Payer: Blue Shield of California Commercial |
$34.28
|
| Rate for Payer: Blue Shield of California EPN |
$27.20
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna of CA HMO |
$37.12
|
| Rate for Payer: Cigna of CA PPO |
$42.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.30
|
| Rate for Payer: Dignity Health Media |
$49.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$43.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.92
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.00
|
| Rate for Payer: United Healthcare All Other HMO |
$29.00
|
| Rate for Payer: United Healthcare HMO Rider |
$29.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.30
|
| Rate for Payer: Vantage Medical Group Senior |
$49.30
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$46.00
|
|
| Hospital Charge Code |
909200075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$39.10 |
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
|
|
HC INTERPRET OUTSIDE FILMS MRI
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
908800075
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC INTERPRET OUTSIDE FILMS MRI
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
908800075
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.79
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.55
|
| Rate for Payer: Blue Shield of California EPN |
$23.45
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Media |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25.00
|
| Rate for Payer: United Healthcare HMO Rider |
$25.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC INTERROGATE SUBQ DEFIB
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
900293261
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
|
|
HC INTERROGATE SUBQ DEFIB
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
900293261
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.20
|
| Rate for Payer: Blue Distinction Transplant |
$85.80
|
| Rate for Payer: Blue Shield of California Commercial |
$84.51
|
| Rate for Payer: Blue Shield of California EPN |
$67.07
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO |
$91.52
|
| Rate for Payer: Cigna of CA PPO |
$105.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.68
|
| Rate for Payer: Dignity Health Media |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$107.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$77.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$76.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Vantage Medical Group Senior |
$47.12
|
|
|
HC INTERSTITIAL INTER
|
Facility
|
OP
|
$39,319.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100405
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$149.82 |
| Max. Negotiated Rate |
$33,421.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,789.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,426.26
|
| Rate for Payer: Blue Distinction Transplant |
$23,591.40
|
| Rate for Payer: Blue Shield of California Commercial |
$23,237.53
|
| Rate for Payer: Blue Shield of California EPN |
$18,440.61
|
| Rate for Payer: Cash Price |
$17,693.55
|
| Rate for Payer: Cash Price |
$17,693.55
|
| Rate for Payer: Cash Price |
$17,693.55
|
| Rate for Payer: Cigna of CA HMO |
$25,164.16
|
| Rate for Payer: Cigna of CA PPO |
$29,096.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.73
|
| Rate for Payer: Dignity Health Media |
$149.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$149.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$149.82
|
| Rate for Payer: Galaxy Health WC |
$33,421.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23,591.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29,489.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$245.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$242.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$242.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$149.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,225.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,436.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.76
|
| Rate for Payer: Multiplan Commercial |
$31,455.20
|
| Rate for Payer: Networks By Design Commercial |
$25,557.35
|
| Rate for Payer: Prime Health Services Commercial |
$33,421.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,591.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Vantage Medical Group Senior |
$149.82
|
|
|
HC INTERSTITIAL INTER
|
Facility
|
IP
|
$39,319.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100405
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$9,436.56 |
| Max. Negotiated Rate |
$33,421.15 |
| Rate for Payer: Cash Price |
$17,693.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,727.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$15,727.60
|
| Rate for Payer: Galaxy Health WC |
$33,421.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23,591.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,225.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,980.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,436.56
|
| Rate for Payer: Multiplan Commercial |
$31,455.20
|
| Rate for Payer: Networks By Design Commercial |
$25,557.35
|
| Rate for Payer: Prime Health Services Commercial |
$33,421.15
|
|
|
HC INTERSTITIAL SIMPLE
|
Facility
|
IP
|
$37,446.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100404
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$8,987.04 |
| Max. Negotiated Rate |
$31,829.10 |
| Rate for Payer: Cash Price |
$16,850.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,978.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$14,978.40
|
| Rate for Payer: Galaxy Health WC |
$31,829.10
|
| Rate for Payer: Global Benefits Group Commercial |
$22,467.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,976.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,266.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,987.04
|
| Rate for Payer: Multiplan Commercial |
$29,956.80
|
| Rate for Payer: Networks By Design Commercial |
$24,339.90
|
| Rate for Payer: Prime Health Services Commercial |
$31,829.10
|
|
|
HC INTERSTITIAL SIMPLE
|
Facility
|
OP
|
$37,446.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100404
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$149.82 |
| Max. Negotiated Rate |
$31,829.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,560.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,310.33
|
| Rate for Payer: Blue Distinction Transplant |
$22,467.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22,130.59
|
| Rate for Payer: Blue Shield of California EPN |
$17,562.17
|
| Rate for Payer: Cash Price |
$16,850.70
|
| Rate for Payer: Cash Price |
$16,850.70
|
| Rate for Payer: Cash Price |
$16,850.70
|
| Rate for Payer: Cigna of CA HMO |
$23,965.44
|
| Rate for Payer: Cigna of CA PPO |
$27,710.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.73
|
| Rate for Payer: Dignity Health Media |
$149.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$149.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$149.82
|
| Rate for Payer: Galaxy Health WC |
$31,829.10
|
| Rate for Payer: Global Benefits Group Commercial |
$22,467.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28,084.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$245.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$242.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$242.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$149.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,976.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,987.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.76
|
| Rate for Payer: Multiplan Commercial |
$29,956.80
|
| Rate for Payer: Networks By Design Commercial |
$24,339.90
|
| Rate for Payer: Prime Health Services Commercial |
$31,829.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,467.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Vantage Medical Group Senior |
$149.82
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
OP
|
$6,617.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$5,624.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,970.20
|
| Rate for Payer: Cash Price |
$2,977.65
|
| Rate for Payer: Cash Price |
$2,977.65
|
| Rate for Payer: Cash Price |
$2,977.65
|
| Rate for Payer: Cigna of CA PPO |
$4,896.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$5,624.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,970.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,962.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,413.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,588.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$5,293.60
|
| Rate for Payer: Networks By Design Commercial |
$4,301.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,624.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,970.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,308.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,308.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,308.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,308.50
|
| 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 INTESTINE CELLVIZIO
|
Facility
|
IP
|
$6,617.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,588.08 |
| Max. Negotiated Rate |
$5,624.45 |
| Rate for Payer: Cash Price |
$2,977.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,646.80
|
| Rate for Payer: Galaxy Health WC |
$5,624.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,970.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,413.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,521.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,588.08
|
| Rate for Payer: Multiplan Commercial |
$5,293.60
|
| Rate for Payer: Networks By Design Commercial |
$4,301.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,624.45
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
IP
|
$6,617.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,588.08 |
| Max. Negotiated Rate |
$5,624.45 |
| Rate for Payer: Cash Price |
$2,977.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,646.80
|
| Rate for Payer: Galaxy Health WC |
$5,624.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,970.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,413.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,521.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,588.08
|
| Rate for Payer: Multiplan Commercial |
$5,293.60
|
| Rate for Payer: Networks By Design Commercial |
$4,301.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,624.45
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
OP
|
$6,617.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,132.59 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,942.41
|
| Rate for Payer: Blue Distinction Transplant |
$3,970.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,977.65
|
| Rate for Payer: Cash Price |
$2,977.65
|
| Rate for Payer: Cigna of CA PPO |
$4,896.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$5,624.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,970.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,962.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,413.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,588.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$5,293.60
|
| Rate for Payer: Networks By Design Commercial |
$4,301.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,624.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,970.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
IP
|
$3,162.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906811310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$758.88 |
| Max. Negotiated Rate |
$2,687.70 |
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,264.80
|
| Rate for Payer: Galaxy Health WC |
$2,687.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,897.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,109.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,204.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.88
|
| Rate for Payer: Multiplan Commercial |
$2,529.60
|
| Rate for Payer: Networks By Design Commercial |
$2,055.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,687.70
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
OP
|
$3,162.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906811310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$411.69 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,631.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,687.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,739.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,739.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,897.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Cigna of CA PPO |
$2,339.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,687.70
|
| Rate for Payer: Dignity Health Media |
$2,687.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,687.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,264.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,264.80
|
| Rate for Payer: Galaxy Health WC |
$2,687.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,897.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,371.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,109.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.88
|
| Rate for Payer: Multiplan Commercial |
$2,529.60
|
| Rate for Payer: Networks By Design Commercial |
$2,055.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,687.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,897.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,687.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,687.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,687.70
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
IP
|
$38,623.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906811745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,269.52 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,449.20
|
| Rate for Payer: Galaxy Health WC |
$32,829.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,173.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,761.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,715.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,269.52
|
| Rate for Payer: Multiplan Commercial |
$30,898.40
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$32,829.55
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
OP
|
$38,623.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906811745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.03 |
| Max. Negotiated Rate |
$32,829.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,850.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,829.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,242.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,242.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$23,173.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Cigna of CA PPO |
$28,581.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,829.55
|
| Rate for Payer: Dignity Health Media |
$32,829.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,829.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,449.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$15,449.20
|
| Rate for Payer: Galaxy Health WC |
$32,829.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,173.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28,967.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,761.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,692.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,269.52
|
| Rate for Payer: Multiplan Commercial |
$30,898.40
|
| Rate for Payer: Networks By Design Commercial |
$25,104.95
|
| Rate for Payer: Prime Health Services Commercial |
$32,829.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,173.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,829.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,829.55
|
| Rate for Payer: Vantage Medical Group Senior |
$32,829.55
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
IP
|
$38,623.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906811746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,269.52 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,449.20
|
| Rate for Payer: Galaxy Health WC |
$32,829.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,173.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,761.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,715.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,269.52
|
| Rate for Payer: Multiplan Commercial |
$30,898.40
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$32,829.55
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
OP
|
$38,623.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906811746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$32,829.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,850.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,829.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,242.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,242.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$23,173.80
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Cigna of CA PPO |
$28,581.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,829.55
|
| Rate for Payer: Dignity Health Media |
$32,829.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,829.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,449.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$15,449.20
|
| Rate for Payer: Galaxy Health WC |
$32,829.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,173.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28,967.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,761.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,269.52
|
| Rate for Payer: Multiplan Commercial |
$30,898.40
|
| Rate for Payer: Networks By Design Commercial |
$25,104.95
|
| Rate for Payer: Prime Health Services Commercial |
$32,829.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,173.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,829.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,829.55
|
| Rate for Payer: Vantage Medical Group Senior |
$32,829.55
|
|
|
HC INTRACAVITARY INTER
|
Facility
|
OP
|
$44,824.00
|
|
|
Service Code
|
CPT 77762
|
| Hospital Charge Code |
909100402
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$735.49 |
| Max. Negotiated Rate |
$38,100.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,306.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$963.93
|
| Rate for Payer: Blue Distinction Transplant |
$26,894.40
|
| Rate for Payer: Blue Shield of California Commercial |
$26,490.98
|
| Rate for Payer: Blue Shield of California EPN |
$21,022.46
|
| Rate for Payer: Cash Price |
$20,170.80
|
| Rate for Payer: Cash Price |
$20,170.80
|
| Rate for Payer: Cigna of CA HMO |
$28,687.36
|
| Rate for Payer: Cigna of CA PPO |
$33,169.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Dignity Health Media |
$735.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$809.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$735.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$735.49
|
| Rate for Payer: Galaxy Health WC |
$38,100.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,894.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33,618.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,206.20
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,206.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,191.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,191.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,897.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$812.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,757.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$985.56
|
| Rate for Payer: Multiplan Commercial |
$35,859.20
|
| Rate for Payer: Networks By Design Commercial |
$29,135.60
|
| Rate for Payer: Prime Health Services Commercial |
$38,100.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,894.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26,894.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,412.00
|
| Rate for Payer: United Healthcare All Other HMO |
$22,412.00
|
| Rate for Payer: United Healthcare HMO Rider |
$22,412.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22,412.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Vantage Medical Group Senior |
$735.49
|
|
|
HC INTRACAVITARY INTER
|
Facility
|
IP
|
$44,824.00
|
|
|
Service Code
|
CPT 77762
|
| Hospital Charge Code |
909100402
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$10,757.76 |
| Max. Negotiated Rate |
$38,100.40 |
| Rate for Payer: Cash Price |
$20,170.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,929.60
|
| Rate for Payer: Galaxy Health WC |
$38,100.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,894.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,897.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,077.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,757.76
|
| Rate for Payer: Multiplan Commercial |
$35,859.20
|
| Rate for Payer: Networks By Design Commercial |
$29,135.60
|
| Rate for Payer: Prime Health Services Commercial |
$38,100.40
|
|
|
HC INTRACAVITARY SIMPLE
|
Facility
|
OP
|
$42,690.00
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
909100401
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$612.71 |
| Max. Negotiated Rate |
$36,286.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,116.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$671.36
|
| Rate for Payer: Blue Distinction Transplant |
$25,614.00
|
| Rate for Payer: Blue Shield of California Commercial |
$25,229.79
|
| Rate for Payer: Blue Shield of California EPN |
$20,021.61
|
| Rate for Payer: Cash Price |
$19,210.50
|
| Rate for Payer: Cash Price |
$19,210.50
|
| Rate for Payer: Cigna of CA HMO |
$27,321.60
|
| Rate for Payer: Cigna of CA PPO |
$31,590.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Dignity Health Media |
$735.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$809.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$735.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$735.49
|
| Rate for Payer: Galaxy Health WC |
$36,286.50
|
| Rate for Payer: Global Benefits Group Commercial |
$25,614.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32,017.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,206.20
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,206.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,191.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,191.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28,474.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,245.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$985.56
|
| Rate for Payer: Multiplan Commercial |
$34,152.00
|
| Rate for Payer: Networks By Design Commercial |
$27,748.50
|
| Rate for Payer: Prime Health Services Commercial |
$36,286.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25,614.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25,614.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$21,345.00
|
| Rate for Payer: United Healthcare All Other HMO |
$21,345.00
|
| Rate for Payer: United Healthcare HMO Rider |
$21,345.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21,345.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Vantage Medical Group Senior |
$735.49
|
|
|
HC INTRACAVITARY SIMPLE
|
Facility
|
IP
|
$42,690.00
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
909100401
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$10,245.60 |
| Max. Negotiated Rate |
$36,286.50 |
| Rate for Payer: Cash Price |
$19,210.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,076.00
|
| Rate for Payer: Galaxy Health WC |
$36,286.50
|
| Rate for Payer: Global Benefits Group Commercial |
$25,614.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28,474.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,264.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,245.60
|
| Rate for Payer: Multiplan Commercial |
$34,152.00
|
| Rate for Payer: Networks By Design Commercial |
$27,748.50
|
| Rate for Payer: Prime Health Services Commercial |
$36,286.50
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
909020161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,088.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$704.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$704.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$768.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna of CA PPO |
$947.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,088.00
|
| Rate for Payer: Dignity Health Media |
$1,088.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,088.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$512.00
|
| Rate for Payer: Galaxy Health WC |
$1,088.00
|
| Rate for Payer: Global Benefits Group Commercial |
$768.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$960.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.20
|
| Rate for Payer: Multiplan Commercial |
$1,024.00
|
| Rate for Payer: Networks By Design Commercial |
$832.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,088.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,088.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,088.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,088.00
|
|
