|
HC INTERNAL CAROTID UNI
|
Facility
|
OP
|
$25,095.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
906820222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$533.35 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$15,057.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$11,292.75
|
| Rate for Payer: Cash Price |
$11,292.75
|
| Rate for Payer: Central Health Plan Commercial |
$20,076.00
|
| Rate for Payer: Cigna of CA PPO |
$18,570.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$21,330.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,057.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,585.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,821.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,329.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: InnovAge PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,738.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,019.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$18,821.25
|
| Rate for Payer: Networks By Design Commercial |
$16,311.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,330.75
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,057.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC INTERP OR EXPL OF FINDINGS
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 90887
|
| Hospital Charge Code |
900100715
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$1,510.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$431.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.75
|
| Rate for Payer: Blue Distinction Transplant |
$120.60
|
| Rate for Payer: Blue Shield of California Commercial |
$126.43
|
| Rate for Payer: Blue Shield of California EPN |
$98.29
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: Cigna of CA HMO |
$128.64
|
| Rate for Payer: Cigna of CA PPO |
$148.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.85
|
| Rate for Payer: Dignity Health Media |
$170.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$150.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: Riverside University Health System MISP |
$80.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,510.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,425.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$984.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.85
|
| Rate for Payer: Vantage Medical Group Senior |
$170.85
|
|
|
HC INTERP OR EXPL OF FINDINGS
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 90887
|
| Hospital Charge Code |
900100715
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
909300075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.27
|
| Rate for Payer: Blue Distinction Transplant |
$34.80
|
| Rate for Payer: Blue Shield of California Commercial |
$35.84
|
| Rate for Payer: Blue Shield of California EPN |
$28.19
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: Cigna of CA HMO |
$37.12
|
| Rate for Payer: Cigna of CA PPO |
$42.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.30
|
| Rate for Payer: Dignity Health Media |
$49.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$43.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
| Rate for Payer: Riverside University Health System MISP |
$23.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.00
|
| Rate for Payer: United Healthcare All Other HMO |
$29.00
|
| Rate for Payer: United Healthcare HMO Rider |
$29.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.30
|
| Rate for Payer: Vantage Medical Group Senior |
$49.30
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
909000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
906600075
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.90
|
| Rate for Payer: Blue Distinction Transplant |
$32.40
|
| Rate for Payer: Blue Shield of California Commercial |
$33.37
|
| Rate for Payer: Blue Shield of California EPN |
$26.24
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.90
|
| Rate for Payer: Dignity Health Media |
$45.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Riverside University Health System MISP |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27.00
|
| Rate for Payer: United Healthcare HMO Rider |
$27.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
909200075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
909000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.27
|
| Rate for Payer: Blue Distinction Transplant |
$34.80
|
| Rate for Payer: Blue Shield of California Commercial |
$35.84
|
| Rate for Payer: Blue Shield of California EPN |
$28.19
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: Cigna of CA HMO |
$37.12
|
| Rate for Payer: Cigna of CA PPO |
$42.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.30
|
| Rate for Payer: Dignity Health Media |
$49.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$43.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
| Rate for Payer: Riverside University Health System MISP |
$23.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.00
|
| Rate for Payer: United Healthcare All Other HMO |
$29.00
|
| Rate for Payer: United Healthcare HMO Rider |
$29.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.30
|
| Rate for Payer: Vantage Medical Group Senior |
$49.30
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
906600075
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
909300075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
909200075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.36
|
| Rate for Payer: Blue Distinction Transplant |
$28.80
|
| Rate for Payer: Blue Shield of California Commercial |
$29.66
|
| Rate for Payer: Blue Shield of California EPN |
$23.33
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Media |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Riverside University Health System MISP |
$19.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Other HMO |
$24.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
HC INTERPRET OUTSIDE FILMS MRI
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
908800075
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC INTERPRET OUTSIDE FILMS MRI
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
908800075
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.72
|
| Rate for Payer: Blue Distinction Transplant |
$31.20
|
| Rate for Payer: Blue Shield of California Commercial |
$32.14
|
| Rate for Payer: Blue Shield of California EPN |
$25.27
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.20
|
| Rate for Payer: Dignity Health Media |
$44.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Riverside University Health System MISP |
$20.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26.00
|
| Rate for Payer: United Healthcare HMO Rider |
$26.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.20
|
| Rate for Payer: Vantage Medical Group Senior |
$44.20
|
|
|
HC INTERROGATE SUBQ DEFIB
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
900293261
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Central Health Plan Commercial |
$114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.60
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
|
|
HC INTERROGATE SUBQ DEFIB
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
900293261
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$47.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$201.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.48
|
| Rate for Payer: Blue Distinction Transplant |
$85.80
|
| Rate for Payer: Blue Shield of California Commercial |
$88.37
|
| Rate for Payer: Blue Shield of California EPN |
$69.50
|
| Rate for Payer: Caremore Medicare Advantage |
$47.12
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Central Health Plan Commercial |
$114.40
|
| Rate for Payer: Cigna of CA HMO |
$91.52
|
| Rate for Payer: Cigna of CA PPO |
$105.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.68
|
| Rate for Payer: Dignity Health Media |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$107.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.12
|
| Rate for Payer: InnovAge PACE Commercial |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Medicare |
$49.95
|
| Rate for Payer: Riverside University Health System MISP |
$51.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Vantage Medical Group Senior |
$47.12
|
|
|
HC INTERSTITIAL INTER
|
Facility
|
IP
|
$47,596.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100405
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$9,519.20 |
| Max. Negotiated Rate |
$42,836.40 |
| Rate for Payer: Cash Price |
$21,418.20
|
| Rate for Payer: Central Health Plan Commercial |
$38,076.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,038.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$19,038.40
|
| Rate for Payer: Galaxy Health WC |
$40,456.60
|
| Rate for Payer: Global Benefits Group Commercial |
$28,557.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,836.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,746.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,134.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,519.20
|
| Rate for Payer: Multiplan Commercial |
$35,697.00
|
| Rate for Payer: Networks By Design Commercial |
$30,937.40
|
| Rate for Payer: Prime Health Services Commercial |
$40,456.60
|
|
|
HC INTERSTITIAL INTER
|
Facility
|
OP
|
$47,596.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100405
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$149.82 |
| Max. Negotiated Rate |
$42,836.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$149.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28,905.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,045.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,119.72
|
| Rate for Payer: Blue Distinction Transplant |
$28,557.60
|
| Rate for Payer: Blue Shield of California Commercial |
$29,414.33
|
| Rate for Payer: Blue Shield of California EPN |
$23,131.66
|
| Rate for Payer: Caremore Medicare Advantage |
$149.82
|
| Rate for Payer: Cash Price |
$21,418.20
|
| Rate for Payer: Cash Price |
$21,418.20
|
| Rate for Payer: Cash Price |
$21,418.20
|
| Rate for Payer: Central Health Plan Commercial |
$38,076.80
|
| Rate for Payer: Cigna of CA HMO |
$30,461.44
|
| Rate for Payer: Cigna of CA PPO |
$35,221.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.73
|
| Rate for Payer: Dignity Health Media |
$149.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$149.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$149.82
|
| Rate for Payer: Galaxy Health WC |
$40,456.60
|
| Rate for Payer: Global Benefits Group Commercial |
$28,557.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,836.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$35,697.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$245.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$247.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$149.82
|
| Rate for Payer: InnovAge PACE Commercial |
$224.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,746.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,519.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.76
|
| Rate for Payer: Multiplan Commercial |
$35,697.00
|
| Rate for Payer: Networks By Design Commercial |
$30,937.40
|
| Rate for Payer: Prime Health Services Commercial |
$40,456.60
|
| Rate for Payer: Prime Health Services Medicare |
$158.81
|
| Rate for Payer: Riverside University Health System MISP |
$164.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,557.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Vantage Medical Group Senior |
$149.82
|
|
|
HC INTERSTITIAL SIMPLE
|
Facility
|
OP
|
$45,330.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100404
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$149.82 |
| Max. Negotiated Rate |
$40,797.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$149.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,528.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21,948.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,780.96
|
| Rate for Payer: Blue Distinction Transplant |
$27,198.00
|
| Rate for Payer: Blue Shield of California Commercial |
$28,013.94
|
| Rate for Payer: Blue Shield of California EPN |
$22,030.38
|
| Rate for Payer: Caremore Medicare Advantage |
$149.82
|
| Rate for Payer: Cash Price |
$20,398.50
|
| Rate for Payer: Cash Price |
$20,398.50
|
| Rate for Payer: Cash Price |
$20,398.50
|
| Rate for Payer: Central Health Plan Commercial |
$36,264.00
|
| Rate for Payer: Cigna of CA HMO |
$29,011.20
|
| Rate for Payer: Cigna of CA PPO |
$33,544.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.73
|
| Rate for Payer: Dignity Health Media |
$149.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$149.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$149.82
|
| Rate for Payer: Galaxy Health WC |
$38,530.50
|
| Rate for Payer: Global Benefits Group Commercial |
$27,198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40,797.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33,997.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$245.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$247.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$149.82
|
| Rate for Payer: InnovAge PACE Commercial |
$224.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30,235.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,066.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.76
|
| Rate for Payer: Multiplan Commercial |
$33,997.50
|
| Rate for Payer: Networks By Design Commercial |
$29,464.50
|
| Rate for Payer: Prime Health Services Commercial |
$38,530.50
|
| Rate for Payer: Prime Health Services Medicare |
$158.81
|
| Rate for Payer: Riverside University Health System MISP |
$164.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27,198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Vantage Medical Group Senior |
$149.82
|
|
|
HC INTERSTITIAL SIMPLE
|
Facility
|
IP
|
$45,330.00
|
|
|
Service Code
|
CPT 77799
|
| Hospital Charge Code |
909100404
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$9,066.00 |
| Max. Negotiated Rate |
$40,797.00 |
| Rate for Payer: Cash Price |
$20,398.50
|
| Rate for Payer: Central Health Plan Commercial |
$36,264.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,132.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$18,132.00
|
| Rate for Payer: Galaxy Health WC |
$38,530.50
|
| Rate for Payer: Global Benefits Group Commercial |
$27,198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40,797.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30,235.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,270.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,066.00
|
| Rate for Payer: Multiplan Commercial |
$33,997.50
|
| Rate for Payer: Networks By Design Commercial |
$29,464.50
|
| Rate for Payer: Prime Health Services Commercial |
$38,530.50
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
OP
|
$8,010.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,132.59 |
| Max. Negotiated Rate |
$7,209.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,878.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,732.31
|
| Rate for Payer: Blue Distinction Transplant |
$4,806.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,038.29
|
| Rate for Payer: Blue Shield of California EPN |
$3,916.89
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,408.00
|
| Rate for Payer: Cigna of CA HMO |
$5,126.40
|
| Rate for Payer: Cigna of CA PPO |
$5,927.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$6,808.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,806.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,209.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,007.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,342.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,602.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$6,007.50
|
| Rate for Payer: Networks By Design Commercial |
$5,206.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,808.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,806.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,806.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,005.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,005.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,005.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,005.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
IP
|
$8,010.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,602.00 |
| Max. Negotiated Rate |
$7,209.00 |
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,408.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,204.00
|
| Rate for Payer: Galaxy Health WC |
$6,808.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,806.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,209.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,342.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,051.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,602.00
|
| Rate for Payer: Multiplan Commercial |
$6,007.50
|
| Rate for Payer: Networks By Design Commercial |
$5,206.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,808.50
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
OP
|
$8,010.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,132.59 |
| Max. Negotiated Rate |
$7,209.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,878.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,732.31
|
| Rate for Payer: Blue Distinction Transplant |
$4,806.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,408.00
|
| Rate for Payer: Cigna of CA PPO |
$5,927.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$6,808.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,806.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,209.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,007.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,342.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,602.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$6,007.50
|
| Rate for Payer: Networks By Design Commercial |
$5,206.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,808.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,806.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
IP
|
$8,010.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,602.00 |
| Max. Negotiated Rate |
$7,209.00 |
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,408.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,204.00
|
| Rate for Payer: Galaxy Health WC |
$6,808.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,806.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,209.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,342.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,051.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,602.00
|
| Rate for Payer: Multiplan Commercial |
$6,007.50
|
| Rate for Payer: Networks By Design Commercial |
$5,206.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,808.50
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
IP
|
$8,010.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,602.00 |
| Max. Negotiated Rate |
$7,209.00 |
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,408.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,204.00
|
| Rate for Payer: Galaxy Health WC |
$6,808.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,806.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,209.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,342.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,051.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,602.00
|
| Rate for Payer: Multiplan Commercial |
$6,007.50
|
| Rate for Payer: Networks By Design Commercial |
$5,206.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,808.50
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
OP
|
$8,010.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,209.00 |
| 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 |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,806.00
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,408.00
|
| Rate for Payer: Cigna of CA PPO |
$5,927.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$6,808.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,806.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,209.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,007.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,342.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,602.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$6,007.50
|
| Rate for Payer: Networks By Design Commercial |
$5,206.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,808.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,806.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,005.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,005.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,005.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,005.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
