|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
909300075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.16
|
| Rate for Payer: Blue Shield of California Commercial |
$35.91
|
| Rate for Payer: Blue Shield of California EPN |
$22.63
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.90
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Riverside University Health System MISP |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$48.45
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
906600075
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.83
|
| Rate for Payer: Blue Shield of California Commercial |
$33.39
|
| Rate for Payer: Blue Shield of California EPN |
$21.04
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: Cigna of CA HMO |
$33.92
|
| Rate for Payer: Cigna of CA PPO |
$39.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.20
|
| Rate for Payer: EPIC Health Plan Senior |
$21.20
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.10
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
| Rate for Payer: Riverside University Health System MISP |
$21.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.50
|
| Rate for Payer: United Healthcare All Other HMO |
$26.50
|
| Rate for Payer: United Healthcare HMO Rider |
$26.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.05
|
| Rate for Payer: Vantage Medical Group Senior |
$45.05
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
909200075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| 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: Health Management Network EPO/PPO |
$45.90
|
| 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 |
$10.20
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
909000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.16
|
| Rate for Payer: Blue Shield of California Commercial |
$35.91
|
| Rate for Payer: Blue Shield of California EPN |
$22.63
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.90
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Riverside University Health System MISP |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$48.45
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
909200075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.97
|
| 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 Exchange |
$24.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.67
|
| Rate for Payer: Blue Shield of California Commercial |
$32.13
|
| Rate for Payer: Blue Shield of California EPN |
$20.25
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| 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: Health Management Network EPO/PPO |
$45.90
|
| 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 |
$10.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.70
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Riverside University Health System MISP |
$20.40
|
| 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 INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
909300075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
909000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
906600075
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.20
|
| Rate for Payer: EPIC Health Plan Senior |
$21.20
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.60
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
|
|
HC INTERPRET OUTSIDE FILMS MRI
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
908800075
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.99
|
| Rate for Payer: Blue Shield of California Commercial |
$34.65
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38.50
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Riverside University Health System MISP |
$22.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.50
|
| Rate for Payer: United Healthcare All Other HMO |
$27.50
|
| Rate for Payer: United Healthcare HMO Rider |
$27.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Vantage Medical Group Senior |
$46.75
|
|
|
HC INTERPRET OUTSIDE FILMS MRI
|
Facility
|
IP
|
$55.00
|
|
| Hospital Charge Code |
908800075
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC INTERROGATE SUBQ DEFIB
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
900293261
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.10
|
| 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 Exchange |
$201.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.48
|
| Rate for Payer: Blue Shield of California Commercial |
$73.08
|
| Rate for Payer: Blue Shield of California EPN |
$46.05
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: Cigna of CA HMO |
$74.24
|
| Rate for Payer: Cigna of CA PPO |
$85.84
|
| 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 |
$81.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$93.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.66
|
| 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 |
$23.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.88
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.60
|
| 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 INTERROGATE SUBQ DEFIB
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
900293261
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Senior |
$46.40
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
|
|
HC INTERROG DEV EVAL 1/DUAL/MLT LEAD IMPL DFIB
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
900200309
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC INTERROG DEV EVAL 1/DUAL/MLT LEAD IMPL DFIB
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
900200309
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.48
|
| 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 Exchange |
$137.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.11
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| 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 |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$100.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.88
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| 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 INTERROG DEV EVAL 1/DUAL/MLT LEAD PM
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
900200308
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.92
|
| 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 Exchange |
$113.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.11
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| 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 |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.88
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| 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 INTERROG DEV EVAL 1/DUAL/MLT LEAD PM
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
900200308
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC INTERROG DEV EVAL IMPL CVL PHYS MNTR SYS
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 93290
|
| Hospital Charge Code |
900200310
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.26
|
| 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 Exchange |
$61.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.11
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| 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 |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.88
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| 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 INTERROG DEV EVAL IMPL CVL PHYS MNTR SYS
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 93290
|
| Hospital Charge Code |
900200310
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC INTERSTITIAL INTER
|
Facility
|
OP
|
$62,945.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100405
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$131.23 |
| Max. Negotiated Rate |
$56,650.50 |
| Rate for Payer: Adventist Health Commercial |
$12,589.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$131.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38,226.50
|
| 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 Exchange |
$30,477.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,615.11
|
| Rate for Payer: Blue Shield of California Commercial |
$39,655.35
|
| Rate for Payer: Blue Shield of California EPN |
$24,989.17
|
| Rate for Payer: Cash Price |
$28,325.25
|
| Rate for Payer: Cash Price |
$28,325.25
|
| Rate for Payer: Cash Price |
$28,325.25
|
| Rate for Payer: Central Health Plan Commercial |
$50,356.00
|
| Rate for Payer: Cigna of CA HMO |
$40,284.80
|
| Rate for Payer: Cigna of CA PPO |
$46,579.30
|
| 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 |
$44,061.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.53
|
| Rate for Payer: EPIC Health Plan Senior |
$144.35
|
| Rate for Payer: Galaxy Health WC |
$53,503.25
|
| Rate for Payer: Global Benefits Group Commercial |
$37,767.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$56,650.50
|
| 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 |
$39,970.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,589.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.85
|
| Rate for Payer: Multiplan Commercial |
$47,208.75
|
| Rate for Payer: Networks By Design Commercial |
$40,914.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$131.23
|
| Rate for Payer: Prime Health Services Commercial |
$53,503.25
|
| Rate for Payer: Prime Health Services Medicare |
$139.10
|
| Rate for Payer: Riverside University Health System MISP |
$144.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37,767.00
|
| 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
|
$62,945.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100405
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$12,589.00 |
| Max. Negotiated Rate |
$56,650.50 |
| Rate for Payer: Adventist Health Commercial |
$12,589.00
|
| Rate for Payer: Cash Price |
$28,325.25
|
| Rate for Payer: Central Health Plan Commercial |
$50,356.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44,061.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$25,178.00
|
| Rate for Payer: Galaxy Health WC |
$53,503.25
|
| Rate for Payer: Global Benefits Group Commercial |
$37,767.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$56,650.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39,970.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37,137.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,589.00
|
| Rate for Payer: Multiplan Commercial |
$47,208.75
|
| Rate for Payer: Networks By Design Commercial |
$40,914.25
|
| Rate for Payer: Prime Health Services Commercial |
$53,503.25
|
|
|
HC INTERSTITIAL SIMPLE
|
Facility
|
IP
|
$59,950.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100404
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$11,990.00 |
| Max. Negotiated Rate |
$53,955.00 |
| Rate for Payer: Adventist Health Commercial |
$11,990.00
|
| Rate for Payer: Cash Price |
$26,977.50
|
| Rate for Payer: Central Health Plan Commercial |
$47,960.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41,965.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,980.00
|
| Rate for Payer: EPIC Health Plan Senior |
$23,980.00
|
| Rate for Payer: Galaxy Health WC |
$50,957.50
|
| Rate for Payer: Global Benefits Group Commercial |
$35,970.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$53,955.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38,068.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,370.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,990.00
|
| Rate for Payer: Multiplan Commercial |
$44,962.50
|
| Rate for Payer: Networks By Design Commercial |
$38,967.50
|
| Rate for Payer: Prime Health Services Commercial |
$50,957.50
|
|
|
HC INTERSTITIAL SIMPLE
|
Facility
|
OP
|
$59,950.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100404
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$131.23 |
| Max. Negotiated Rate |
$53,955.00 |
| Rate for Payer: Adventist Health Commercial |
$11,990.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$131.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36,407.64
|
| 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 Exchange |
$29,027.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,872.92
|
| Rate for Payer: Blue Shield of California Commercial |
$37,768.50
|
| Rate for Payer: Blue Shield of California EPN |
$23,800.15
|
| Rate for Payer: Cash Price |
$26,977.50
|
| Rate for Payer: Cash Price |
$26,977.50
|
| Rate for Payer: Cash Price |
$26,977.50
|
| Rate for Payer: Central Health Plan Commercial |
$47,960.00
|
| Rate for Payer: Cigna of CA HMO |
$38,368.00
|
| Rate for Payer: Cigna of CA PPO |
$44,363.00
|
| 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 |
$41,965.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.53
|
| Rate for Payer: EPIC Health Plan Senior |
$144.35
|
| Rate for Payer: Galaxy Health WC |
$50,957.50
|
| Rate for Payer: Global Benefits Group Commercial |
$35,970.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$53,955.00
|
| 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 |
$38,068.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,990.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.85
|
| Rate for Payer: Multiplan Commercial |
$44,962.50
|
| Rate for Payer: Networks By Design Commercial |
$38,967.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$131.23
|
| Rate for Payer: Prime Health Services Commercial |
$50,957.50
|
| Rate for Payer: Prime Health Services Medicare |
$139.10
|
| Rate for Payer: Riverside University Health System MISP |
$144.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35,970.00
|
| 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 INTESTINE CELLVIZIO
|
Facility
|
IP
|
$10,594.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,118.80 |
| Max. Negotiated Rate |
$9,534.60 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,475.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,415.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,237.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,237.60
|
| Rate for Payer: Galaxy Health WC |
$9,004.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,356.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,534.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,727.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,250.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.80
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
| Rate for Payer: Networks By Design Commercial |
$6,886.10
|
| Rate for Payer: Prime Health Services Commercial |
$9,004.90
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
IP
|
$10,594.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,118.80 |
| Max. Negotiated Rate |
$9,534.60 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,475.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,415.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,237.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,237.60
|
| Rate for Payer: Galaxy Health WC |
$9,004.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,356.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,534.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,727.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,250.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.80
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
| Rate for Payer: Networks By Design Commercial |
$6,886.10
|
| Rate for Payer: Prime Health Services Commercial |
$9,004.90
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
OP
|
$10,594.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,166.53 |
| Max. Negotiated Rate |
$9,534.60 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,433.74
|
| 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 Exchange |
$5,129.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,162.53
|
| Rate for Payer: Blue Shield of California Commercial |
$6,716.60
|
| Rate for Payer: Blue Shield of California EPN |
$4,227.01
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,475.20
|
| Rate for Payer: Cigna of CA HMO |
$6,780.16
|
| Rate for Payer: Cigna of CA PPO |
$7,839.56
|
| 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 |
$7,415.80
|
| 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 |
$9,004.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,356.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,534.60
|
| 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 |
$6,727.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
| Rate for Payer: Networks By Design Commercial |
$6,886.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$9,004.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,356.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,356.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,297.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,297.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,297.00
|
| 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
|
|
