|
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: 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 Permanente of CA Commercial/Self Funded |
$77.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.80
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.18
|
| 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 |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$47.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$137.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| 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: 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 |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.96
|
| Rate for Payer: EPIC Health Plan Senior |
$47.38
|
| 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 |
$77.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$100.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: InnovAge PACE Commercial |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.49
|
| 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 |
$47.38
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.22
|
| Rate for Payer: Riverside University Health System MISP |
$52.12
|
| 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 |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
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 |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$47.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| 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: 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 |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.96
|
| Rate for Payer: EPIC Health Plan Senior |
$47.38
|
| 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 |
$77.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: InnovAge PACE Commercial |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.49
|
| 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 |
$47.38
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.22
|
| Rate for Payer: Riverside University Health System MISP |
$52.12
|
| 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 |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.18
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.18
|
| 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 |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$47.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| 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: 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 |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.96
|
| Rate for Payer: EPIC Health Plan Senior |
$47.38
|
| 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 |
$77.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: InnovAge PACE Commercial |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.49
|
| 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 |
$47.38
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.22
|
| Rate for Payer: Riverside University Health System MISP |
$52.12
|
| 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 |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$41,984.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,982.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38,962.96
|
| 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 INTER
|
Facility
|
OP
|
$62,945.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100405
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$139.13 |
| Max. Negotiated Rate |
$56,650.50 |
| Rate for Payer: Adventist Health Commercial |
$12,589.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$139.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38,226.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$208.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30,477.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,967.60
|
| Rate for Payer: Blue Shield of California Commercial |
$38,207.61
|
| 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 |
$208.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$139.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.83
|
| Rate for Payer: EPIC Health Plan Senior |
$139.13
|
| 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 |
$228.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$139.13
|
| Rate for Payer: InnovAge PACE Commercial |
$208.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41,984.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,589.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.43
|
| 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 |
$139.13
|
| Rate for Payer: Prime Health Services Commercial |
$53,503.25
|
| Rate for Payer: Prime Health Services Medicare |
$147.48
|
| Rate for Payer: Riverside University Health System MISP |
$153.04
|
| 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 |
$139.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$208.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.04
|
| Rate for Payer: Vantage Medical Group Senior |
$139.13
|
|
|
HC INTERSTITIAL SIMPLE
|
Facility
|
OP
|
$59,950.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100404
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$139.13 |
| Max. Negotiated Rate |
$53,955.00 |
| Rate for Payer: Adventist Health Commercial |
$11,990.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$139.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36,407.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$208.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29,027.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35,208.64
|
| Rate for Payer: Blue Shield of California Commercial |
$36,389.65
|
| 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 |
$208.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$139.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.83
|
| Rate for Payer: EPIC Health Plan Senior |
$139.13
|
| 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 |
$228.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$139.13
|
| Rate for Payer: InnovAge PACE Commercial |
$208.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39,986.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,990.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.43
|
| 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 |
$139.13
|
| Rate for Payer: Prime Health Services Commercial |
$50,957.50
|
| Rate for Payer: Prime Health Services Medicare |
$147.48
|
| Rate for Payer: Riverside University Health System MISP |
$153.04
|
| 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 |
$139.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$208.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.04
|
| Rate for Payer: Vantage Medical Group Senior |
$139.13
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$39,986.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,840.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,109.05
|
| 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 INTESTINE CELLVIZIO
|
Facility
|
OP
|
$10,594.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,191.26 |
| Max. Negotiated Rate |
$9,534.60 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,472.93
|
| 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: 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 |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| 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 |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,066.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| 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 |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$9,004.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| 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 |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
IP
|
$10,594.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
450
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$7,066.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,036.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,557.69
|
| 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
|
750
|
| Min. Negotiated Rate |
$1,191.26 |
| Max. Negotiated Rate |
$9,534.60 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,767.30
|
| 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 |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| 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 |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,066.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| 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 |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$9,004.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,356.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| 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 |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$7,066.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,036.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,557.69
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$7,066.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,036.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,557.69
|
| 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
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,534.60 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Cash Price |
$4,767.30
|
| 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 |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| 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 |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,066.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$6,886.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,004.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC INTL CUSTM CONG/ATYP INSERT
|
Facility
|
IP
|
$1,868.00
|
|
|
Service Code
|
CPT L5681
|
| Hospital Charge Code |
915340558
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.60 |
| Max. Negotiated Rate |
$1,681.20 |
| Rate for Payer: Adventist Health Commercial |
$373.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,443.96
|
| Rate for Payer: Blue Shield of California EPN |
$941.47
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,494.40
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Senior |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,681.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$711.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,156.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.60
|
| Rate for Payer: Multiplan Commercial |
$1,401.00
|
| Rate for Payer: Networks By Design Commercial |
$1,214.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.06
|
| Rate for Payer: United Healthcare All Other HMO |
$682.38
|
| Rate for Payer: United Healthcare HMO Rider |
$667.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.77
|
|
|
HC INTL CUSTM CONG/ATYP INSERT
|
Facility
|
OP
|
$1,868.00
|
|
|
Service Code
|
CPT L5681
|
| Hospital Charge Code |
915340558
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$611.77 |
| Max. Negotiated Rate |
$1,681.20 |
| Rate for Payer: Adventist Health Commercial |
$765.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,401.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,443.96
|
| Rate for Payer: Blue Shield of California EPN |
$941.47
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,494.40
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,587.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,587.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Senior |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,681.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: InnovAge PACE Commercial |
$934.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,156.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$765.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,307.60
|
| Rate for Payer: Multiplan Commercial |
$1,401.00
|
| Rate for Payer: Networks By Design Commercial |
$934.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: Riverside University Health System MISP |
$747.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,120.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,120.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.06
|
| Rate for Payer: United Healthcare All Other HMO |
$682.38
|
| Rate for Payer: United Healthcare HMO Rider |
$667.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,587.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,587.80
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
IP
|
$2,553.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906811310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$510.60 |
| Max. Negotiated Rate |
$2,297.70 |
| Rate for Payer: Adventist Health Commercial |
$510.60
|
| Rate for Payer: Cash Price |
$1,148.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,042.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,021.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,021.20
|
| Rate for Payer: Galaxy Health WC |
$2,170.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,531.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,297.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,702.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$972.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,580.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.60
|
| Rate for Payer: Multiplan Commercial |
$1,914.75
|
| Rate for Payer: Networks By Design Commercial |
$1,659.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,170.05
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
OP
|
$2,553.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906811310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$372.69 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$510.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,170.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,404.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,914.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,236.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,499.38
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,148.85
|
| Rate for Payer: Cash Price |
$1,148.85
|
| Rate for Payer: Cash Price |
$1,148.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,042.40
|
| Rate for Payer: Cigna of CA HMO |
$1,633.92
|
| Rate for Payer: Cigna of CA PPO |
$1,889.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,170.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,170.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,170.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,021.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,021.20
|
| Rate for Payer: Galaxy Health WC |
$2,170.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,531.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,297.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$372.69
|
| Rate for Payer: InnovAge PACE Commercial |
$1,276.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,702.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,580.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,787.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,787.10
|
| Rate for Payer: Multiplan Commercial |
$1,914.75
|
| Rate for Payer: Networks By Design Commercial |
$1,659.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,170.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,021.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,531.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,170.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,170.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,170.05
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
IP
|
$3,004.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906820104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.80 |
| Max. Negotiated Rate |
$2,703.60 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,403.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.60
|
| Rate for Payer: Galaxy Health WC |
$2,553.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,802.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,703.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,144.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,859.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.80
|
| Rate for Payer: Multiplan Commercial |
$2,253.00
|
| Rate for Payer: Networks By Design Commercial |
$1,952.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,553.40
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
OP
|
$3,004.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906820104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$372.69 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,553.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,652.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,253.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,454.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,764.25
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,403.20
|
| Rate for Payer: Cigna of CA HMO |
$1,922.56
|
| Rate for Payer: Cigna of CA PPO |
$2,222.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,553.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,553.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,553.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.60
|
| Rate for Payer: Galaxy Health WC |
$2,553.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,802.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,703.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$372.69
|
| Rate for Payer: InnovAge PACE Commercial |
$1,502.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,859.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,102.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,102.80
|
| Rate for Payer: Multiplan Commercial |
$2,253.00
|
| Rate for Payer: Networks By Design Commercial |
$1,952.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,553.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,201.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,802.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,553.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,553.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,553.40
|
|
|
HC INTRA-ART INJ OR INFUS
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 96379
|
| Hospital Charge Code |
911896379
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$755.10 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$58.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$509.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$406.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$492.74
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Central Health Plan Commercial |
$671.20
|
| Rate for Payer: Cigna of CA HMO |
$536.96
|
| Rate for Payer: Cigna of CA PPO |
$620.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| Rate for Payer: Galaxy Health WC |
$713.15
|
| Rate for Payer: Global Benefits Group Commercial |
$503.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$755.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: InnovAge PACE Commercial |
$87.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$559.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| Rate for Payer: Multiplan Commercial |
$629.25
|
| Rate for Payer: Networks By Design Commercial |
$545.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$58.63
|
| Rate for Payer: Prime Health Services Commercial |
$713.15
|
| Rate for Payer: Prime Health Services Medicare |
$62.15
|
| Rate for Payer: Riverside University Health System MISP |
$64.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$503.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC INTRA-ART INJ OR INFUS
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
CPT 96379
|
| Hospital Charge Code |
911896379
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$167.80 |
| Max. Negotiated Rate |
$755.10 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Central Health Plan Commercial |
$671.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$335.60
|
| Rate for Payer: EPIC Health Plan Senior |
$335.60
|
| Rate for Payer: Galaxy Health WC |
$713.15
|
| Rate for Payer: Global Benefits Group Commercial |
$503.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$755.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$559.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$519.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.80
|
| Rate for Payer: Multiplan Commercial |
$629.25
|
| Rate for Payer: Networks By Design Commercial |
$545.35
|
| Rate for Payer: Prime Health Services Commercial |
$713.15
|
|
