|
HC INTERNAL CAROTID UNI
|
Facility
|
OP
|
$21,331.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
909020147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$471.59 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$4,266.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$9,598.95
|
| Rate for Payer: Cash Price |
$9,598.95
|
| Rate for Payer: Cash Price |
$9,598.95
|
| Rate for Payer: Cigna of CA HMO |
$13,651.84
|
| Rate for Payer: Cigna of CA PPO |
$15,784.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,931.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Galaxy Health WC |
$18,131.35
|
| Rate for Payer: Global Benefits Group Commercial |
$12,798.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$471.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,545.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$533.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,119.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,017.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$17,064.80
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$13,865.15
|
| Rate for Payer: Prime Health Services Commercial |
$18,131.35
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,798.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,665.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC INTERNAL CAROTID UNI
|
Facility
|
IP
|
$21,331.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
909020147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,266.20 |
| Max. Negotiated Rate |
$18,131.35 |
| Rate for Payer: Adventist Health Commercial |
$4,266.20
|
| Rate for Payer: Cash Price |
$9,598.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,931.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,532.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,532.40
|
| Rate for Payer: Galaxy Health WC |
$18,131.35
|
| Rate for Payer: Global Benefits Group Commercial |
$12,798.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,545.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,585.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,119.44
|
| Rate for Payer: Multiplan Commercial |
$17,064.80
|
| Rate for Payer: Networks By Design Commercial |
$13,865.15
|
| Rate for Payer: Prime Health Services Commercial |
$18,131.35
|
|
|
HC INTERPHASE INSITU HYBRID
|
Facility
|
OP
|
$515.11
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
903800158
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.46 |
| Max. Negotiated Rate |
$2,701.73 |
| Rate for Payer: Adventist Health Commercial |
$103.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,701.73
|
| Rate for Payer: Blue Shield of California Commercial |
$237.47
|
| Rate for Payer: Blue Shield of California Commercial |
$359.03
|
| Rate for Payer: Cash Price |
$231.80
|
| Rate for Payer: Cash Price |
$231.80
|
| Rate for Payer: Cigna of CA HMO |
$329.67
|
| Rate for Payer: Cigna of CA PPO |
$381.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$360.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.46
|
| Rate for Payer: EPIC Health Plan Senior |
$56.31
|
| Rate for Payer: Galaxy Health WC |
$437.84
|
| Rate for Payer: Global Benefits Group Commercial |
$309.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$327.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$412.09
|
| Rate for Payer: Networks By Design Commercial |
$334.82
|
| Rate for Payer: Prime Health Services Commercial |
$437.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$309.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC INTERPHASE INSITU HYBRID
|
Facility
|
IP
|
$515.11
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
903800158
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$103.02 |
| Max. Negotiated Rate |
$437.84 |
| Rate for Payer: Adventist Health Commercial |
$103.02
|
| Rate for Payer: Cash Price |
$231.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$360.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.04
|
| Rate for Payer: EPIC Health Plan Senior |
$206.04
|
| Rate for Payer: Galaxy Health WC |
$437.84
|
| Rate for Payer: Global Benefits Group Commercial |
$309.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$327.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.63
|
| Rate for Payer: Multiplan Commercial |
$412.09
|
| Rate for Payer: Networks By Design Commercial |
$334.82
|
| Rate for Payer: Prime Health Services Commercial |
$437.84
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$76.00
|
|
| Hospital Charge Code |
909000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$43.00
|
|
| Hospital Charge Code |
908100075
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.59
|
| Rate for Payer: Blue Shield of California Commercial |
$18.10
|
| Rate for Payer: Blue Shield of California Commercial |
$27.43
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: EPIC Health Plan Senior |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.10
|
| Rate for Payer: Multiplan Commercial |
$34.40
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.55
|
| Rate for Payer: Vantage Medical Group Senior |
$36.55
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$43.00
|
|
| Hospital Charge Code |
908100075
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$36.55 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: EPIC Health Plan Senior |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$34.40
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$76.00
|
|
| Hospital Charge Code |
909000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.77
|
| Rate for Payer: Blue Shield of California Commercial |
$32.00
|
| Rate for Payer: Blue Shield of California Commercial |
$48.49
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.00
|
| Rate for Payer: United Healthcare All Other HMO |
$38.00
|
| Rate for Payer: United Healthcare HMO Rider |
$38.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$71.00
|
|
| Hospital Charge Code |
906600075
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$60.35 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.56
|
| Rate for Payer: Blue Shield of California Commercial |
$29.89
|
| Rate for Payer: Blue Shield of California Commercial |
$45.30
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: EPIC Health Plan Senior |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.70
|
| Rate for Payer: Multiplan Commercial |
$56.80
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.50
|
| Rate for Payer: United Healthcare All Other HMO |
$35.50
|
| Rate for Payer: United Healthcare HMO Rider |
$35.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.35
|
| Rate for Payer: Vantage Medical Group Senior |
$60.35
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$47.00
|
|
| Hospital Charge Code |
909200075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.16
|
| Rate for Payer: Blue Shield of California Commercial |
$19.79
|
| Rate for Payer: Blue Shield of California Commercial |
$29.99
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$30.08
|
| Rate for Payer: Cigna of CA PPO |
$34.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.90
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.50
|
| Rate for Payer: United Healthcare All Other HMO |
$23.50
|
| Rate for Payer: United Healthcare HMO Rider |
$23.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.95
|
| Rate for Payer: Vantage Medical Group Senior |
$39.95
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$76.00
|
|
| Hospital Charge Code |
909300075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.77
|
| Rate for Payer: Blue Shield of California Commercial |
$32.00
|
| Rate for Payer: Blue Shield of California Commercial |
$48.49
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.00
|
| Rate for Payer: United Healthcare All Other HMO |
$38.00
|
| Rate for Payer: United Healthcare HMO Rider |
$38.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$76.00
|
|
| Hospital Charge Code |
909300075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$47.00
|
|
| Hospital Charge Code |
909200075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$71.00
|
|
| Hospital Charge Code |
906600075
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$60.35 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: EPIC Health Plan Senior |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$56.80
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
|
|
HC INTERPRET OUTSIDE FILMS MRI
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
908800075
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$43.35 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
|
|
HC INTERPRET OUTSIDE FILMS MRI
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
908800075
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$43.35 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.73
|
| Rate for Payer: Blue Shield of California Commercial |
$21.47
|
| Rate for Payer: Blue Shield of California Commercial |
$32.54
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.70
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.50
|
| Rate for Payer: United Healthcare All Other HMO |
$25.50
|
| Rate for Payer: United Healthcare HMO Rider |
$25.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.35
|
| Rate for Payer: Vantage Medical Group Senior |
$43.35
|
|
|
HC INTERROGATE SUBQ DEFIB
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
900293261
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$118.15 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$97.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.60
|
| Rate for Payer: EPIC Health Plan Senior |
$55.60
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.36
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
|
|
HC INTERROGATE SUBQ DEFIB
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
900293261
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.20
|
| Rate for Payer: Blue Shield of California Commercial |
$58.52
|
| Rate for Payer: Blue Shield of California Commercial |
$88.68
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cigna of CA HMO |
$88.96
|
| Rate for Payer: Cigna of CA PPO |
$102.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$97.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC INTERSTITIAL INTER
|
Facility
|
OP
|
$31,750.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100405
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$131.23 |
| Max. Negotiated Rate |
$26,987.50 |
| Rate for Payer: Adventist Health Commercial |
$6,350.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20,824.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,373.97
|
| Rate for Payer: Blue Shield of California Commercial |
$13,366.75
|
| Rate for Payer: Blue Shield of California Commercial |
$20,256.50
|
| Rate for Payer: Cash Price |
$14,287.50
|
| Rate for Payer: Cash Price |
$14,287.50
|
| Rate for Payer: Cash Price |
$14,287.50
|
| Rate for Payer: Cigna of CA HMO |
$20,320.00
|
| Rate for Payer: Cigna of CA PPO |
$23,495.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.53
|
| Rate for Payer: EPIC Health Plan Senior |
$144.35
|
| Rate for Payer: Galaxy Health WC |
$26,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$19,050.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$215.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$131.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,161.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,620.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$165.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.85
|
| Rate for Payer: Multiplan Commercial |
$25,400.00
|
| Rate for Payer: Networks By Design Commercial |
$20,637.50
|
| Rate for Payer: Prime Health Services Commercial |
$26,987.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$131.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Vantage Medical Group Senior |
$131.23
|
|
|
HC INTERSTITIAL INTER
|
Facility
|
IP
|
$31,750.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100405
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$6,350.00 |
| Max. Negotiated Rate |
$26,987.50 |
| Rate for Payer: Adventist Health Commercial |
$6,350.00
|
| Rate for Payer: Cash Price |
$14,287.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,700.00
|
| Rate for Payer: Galaxy Health WC |
$26,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$19,050.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,161.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,732.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,620.00
|
| Rate for Payer: Multiplan Commercial |
$25,400.00
|
| Rate for Payer: Networks By Design Commercial |
$20,637.50
|
| Rate for Payer: Prime Health Services Commercial |
$26,987.50
|
|
|
HC INTERSTITIAL SIMPLE
|
Facility
|
OP
|
$30,237.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100404
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$131.23 |
| Max. Negotiated Rate |
$25,701.45 |
| Rate for Payer: Adventist Health Commercial |
$6,047.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19,832.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,403.08
|
| Rate for Payer: Blue Shield of California Commercial |
$12,729.78
|
| Rate for Payer: Blue Shield of California Commercial |
$19,291.21
|
| Rate for Payer: Cash Price |
$13,606.65
|
| Rate for Payer: Cash Price |
$13,606.65
|
| Rate for Payer: Cash Price |
$13,606.65
|
| Rate for Payer: Cigna of CA HMO |
$19,351.68
|
| Rate for Payer: Cigna of CA PPO |
$22,375.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,165.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.53
|
| Rate for Payer: EPIC Health Plan Senior |
$144.35
|
| Rate for Payer: Galaxy Health WC |
$25,701.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,142.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$215.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$131.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,200.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,256.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$165.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.85
|
| Rate for Payer: Multiplan Commercial |
$24,189.60
|
| Rate for Payer: Networks By Design Commercial |
$19,654.05
|
| Rate for Payer: Prime Health Services Commercial |
$25,701.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,142.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$131.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Vantage Medical Group Senior |
$131.23
|
|
|
HC INTERSTITIAL SIMPLE
|
Facility
|
IP
|
$30,237.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100404
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$6,047.40 |
| Max. Negotiated Rate |
$25,701.45 |
| Rate for Payer: Adventist Health Commercial |
$6,047.40
|
| Rate for Payer: Cash Price |
$13,606.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,165.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,094.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12,094.80
|
| Rate for Payer: Galaxy Health WC |
$25,701.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,142.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,200.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,839.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,256.88
|
| Rate for Payer: Multiplan Commercial |
$24,189.60
|
| Rate for Payer: Networks By Design Commercial |
$19,654.05
|
| Rate for Payer: Prime Health Services Commercial |
$25,701.45
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
IP
|
$5,343.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,068.60 |
| Max. Negotiated Rate |
$4,541.55 |
| Rate for Payer: Adventist Health Commercial |
$1,068.60
|
| Rate for Payer: Cash Price |
$2,404.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,740.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,137.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,137.20
|
| Rate for Payer: Galaxy Health WC |
$4,541.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,205.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,392.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,152.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.32
|
| Rate for Payer: Multiplan Commercial |
$4,274.40
|
| Rate for Payer: Networks By Design Commercial |
$3,472.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,541.55
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
IP
|
$5,343.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,068.60 |
| Max. Negotiated Rate |
$4,541.55 |
| Rate for Payer: Adventist Health Commercial |
$1,068.60
|
| Rate for Payer: Cash Price |
$2,404.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,740.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,137.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,137.20
|
| Rate for Payer: Galaxy Health WC |
$4,541.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,205.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,392.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,152.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.32
|
| Rate for Payer: Multiplan Commercial |
$4,274.40
|
| Rate for Payer: Networks By Design Commercial |
$3,472.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,541.55
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
OP
|
$5,343.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,068.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,068.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,428.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$2,404.35
|
| Rate for Payer: Cash Price |
$2,404.35
|
| Rate for Payer: Cash Price |
$2,404.35
|
| Rate for Payer: Cigna of CA HMO |
$3,419.52
|
| Rate for Payer: Cigna of CA PPO |
$3,953.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,740.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$4,541.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,205.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,392.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,274.40
|
| Rate for Payer: Networks By Design Commercial |
$3,472.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,541.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,205.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,671.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
