|
HC INJ ANTGRD NEPH AND OR URETER
|
Facility
|
OP
|
$2,637.00
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
909050430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$632.88 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$853.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,582.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,186.65
|
| Rate for Payer: Cash Price |
$1,186.65
|
| Rate for Payer: Cigna of CA PPO |
$1,951.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Dignity Health Media |
$853.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$853.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$853.50
|
| Rate for Payer: Galaxy Health WC |
$2,241.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,977.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,399.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,382.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,382.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$853.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,758.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$902.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$853.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,143.69
|
| Rate for Payer: Multiplan Commercial |
$2,109.60
|
| Rate for Payer: Networks By Design Commercial |
$1,714.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,241.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,582.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Vantage Medical Group Senior |
$853.50
|
|
|
HC INJ CHEST TUBE W/FIBRINOLYTIC
|
Facility
|
OP
|
$2,102.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
909020046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$151.37 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,261.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$945.90
|
| Rate for Payer: Cash Price |
$945.90
|
| Rate for Payer: Cigna of CA PPO |
$1,555.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$1,786.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,261.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,576.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,402.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$1,681.60
|
| Rate for Payer: Networks By Design Commercial |
$1,366.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,786.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,261.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC INJ CHEST TUBE W/FIBRINOLYTIC
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
909020047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,327.80
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cigna of CA PPO |
$1,637.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$1,881.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,327.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,659.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,476.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$1,770.40
|
| Rate for Payer: Networks By Design Commercial |
$1,438.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,881.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,327.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC INJ CHEST TUBE W/FIBRINOLYTIC
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
909020047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$531.12 |
| Max. Negotiated Rate |
$1,881.05 |
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.20
|
| Rate for Payer: Galaxy Health WC |
$1,881.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,327.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,476.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$843.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.12
|
| Rate for Payer: Multiplan Commercial |
$1,770.40
|
| Rate for Payer: Networks By Design Commercial |
$1,438.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,881.05
|
|
|
HC INJ CHEST TUBE W/FIBRINOLYTIC
|
Facility
|
IP
|
$2,102.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
909020046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$504.48 |
| Max. Negotiated Rate |
$1,786.70 |
| Rate for Payer: Cash Price |
$945.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$840.80
|
| Rate for Payer: Galaxy Health WC |
$1,786.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,261.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,402.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$800.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.48
|
| Rate for Payer: Multiplan Commercial |
$1,681.60
|
| Rate for Payer: Networks By Design Commercial |
$1,366.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,786.70
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$437.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$309.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Cigna of CA PPO |
$381.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$437.75
|
| Rate for Payer: Dignity Health Media |
$437.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$437.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$206.00
|
| Rate for Payer: Galaxy Health WC |
$437.75
|
| Rate for Payer: Global Benefits Group Commercial |
$309.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$386.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$343.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: Networks By Design Commercial |
$334.75
|
| Rate for Payer: Prime Health Services Commercial |
$437.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$309.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$437.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$437.75
|
| Rate for Payer: Vantage Medical Group Senior |
$437.75
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$437.75 |
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.00
|
| Rate for Payer: Galaxy Health WC |
$437.75
|
| Rate for Payer: Global Benefits Group Commercial |
$309.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$343.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: Networks By Design Commercial |
$334.75
|
| Rate for Payer: Prime Health Services Commercial |
$437.75
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$437.75 |
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.00
|
| Rate for Payer: Galaxy Health WC |
$437.75
|
| Rate for Payer: Global Benefits Group Commercial |
$309.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$343.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: Networks By Design Commercial |
$334.75
|
| Rate for Payer: Prime Health Services Commercial |
$437.75
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$437.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$309.00
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Cigna of CA PPO |
$381.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$437.75
|
| Rate for Payer: Dignity Health Media |
$437.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$437.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$206.00
|
| Rate for Payer: Galaxy Health WC |
$437.75
|
| Rate for Payer: Global Benefits Group Commercial |
$309.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$386.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$343.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: Networks By Design Commercial |
$334.75
|
| Rate for Payer: Prime Health Services Commercial |
$437.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$309.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.50
|
| Rate for Payer: United Healthcare All Other HMO |
$257.50
|
| Rate for Payer: United Healthcare HMO Rider |
$257.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$437.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$437.75
|
| Rate for Payer: Vantage Medical Group Senior |
$437.75
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906811575
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$609.64 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$609.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,612.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,612.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,830.05
|
| Rate for Payer: Blue Distinction Transplant |
$2,850.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cigna of CA HMO |
$3,040.00
|
| Rate for Payer: Cigna of CA PPO |
$3,515.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Dignity Health Media |
$4,037.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,900.00
|
| Rate for Payer: Galaxy Health WC |
$4,037.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,562.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.00
|
| Rate for Payer: Multiplan Commercial |
$3,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,087.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,037.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,850.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,850.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,037.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906811575
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,140.00 |
| Max. Negotiated Rate |
$4,037.50 |
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.00
|
| Rate for Payer: Galaxy Health WC |
$4,037.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,809.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.00
|
| Rate for Payer: Multiplan Commercial |
$3,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,087.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,037.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906811573
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$412.96 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$412.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,612.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,612.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,830.05
|
| Rate for Payer: Blue Distinction Transplant |
$2,850.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cigna of CA HMO |
$3,040.00
|
| Rate for Payer: Cigna of CA PPO |
$3,515.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Dignity Health Media |
$4,037.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,900.00
|
| Rate for Payer: Galaxy Health WC |
$4,037.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,562.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.00
|
| Rate for Payer: Multiplan Commercial |
$3,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,087.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,037.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,850.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,850.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,037.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906811573
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,140.00 |
| Max. Negotiated Rate |
$4,037.50 |
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.00
|
| Rate for Payer: Galaxy Health WC |
$4,037.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,809.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.00
|
| Rate for Payer: Multiplan Commercial |
$3,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,087.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,037.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906811569
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$247.78 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$247.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,612.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,612.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,830.05
|
| Rate for Payer: Blue Distinction Transplant |
$2,850.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cigna of CA HMO |
$3,040.00
|
| Rate for Payer: Cigna of CA PPO |
$3,515.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Dignity Health Media |
$4,037.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,900.00
|
| Rate for Payer: Galaxy Health WC |
$4,037.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,562.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.00
|
| Rate for Payer: Multiplan Commercial |
$3,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,087.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,037.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,850.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,850.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,037.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906811569
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,140.00 |
| Max. Negotiated Rate |
$4,037.50 |
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.00
|
| Rate for Payer: Galaxy Health WC |
$4,037.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,809.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.00
|
| Rate for Payer: Multiplan Commercial |
$3,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,087.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,037.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906811574
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,140.00 |
| Max. Negotiated Rate |
$4,037.50 |
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.00
|
| Rate for Payer: Galaxy Health WC |
$4,037.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,809.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.00
|
| Rate for Payer: Multiplan Commercial |
$3,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,087.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,037.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906811574
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$455.65 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$455.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,612.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,612.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,830.05
|
| Rate for Payer: Blue Distinction Transplant |
$2,850.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cigna of CA HMO |
$3,040.00
|
| Rate for Payer: Cigna of CA PPO |
$3,515.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Dignity Health Media |
$4,037.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,900.00
|
| Rate for Payer: Galaxy Health WC |
$4,037.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,562.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.00
|
| Rate for Payer: Multiplan Commercial |
$3,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,087.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,037.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,850.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,850.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,037.50
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
OP
|
$1,382.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.68 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$829.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$621.90
|
| Rate for Payer: Cash Price |
$621.90
|
| Rate for Payer: Cigna of CA PPO |
$1,022.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$1,174.70
|
| Rate for Payer: Global Benefits Group Commercial |
$829.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,036.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,867.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$1,105.60
|
| Rate for Payer: Networks By Design Commercial |
$898.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,174.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$829.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
OP
|
$1,382.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$266.68 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$829.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$621.90
|
| Rate for Payer: Cash Price |
$621.90
|
| Rate for Payer: Cigna of CA PPO |
$1,022.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$1,174.70
|
| Rate for Payer: Global Benefits Group Commercial |
$829.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,036.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,867.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$1,105.60
|
| Rate for Payer: Networks By Design Commercial |
$898.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,174.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$829.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,366.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
IP
|
$2,501.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$600.24 |
| Max. Negotiated Rate |
$2,125.85 |
| Rate for Payer: Cash Price |
$1,125.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,125.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.24
|
| Rate for Payer: Multiplan Commercial |
$2,000.80
|
| Rate for Payer: Networks By Design Commercial |
$1,625.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.85
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
IP
|
$2,501.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.24 |
| Max. Negotiated Rate |
$2,125.85 |
| Rate for Payer: Cash Price |
$1,125.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,125.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.24
|
| Rate for Payer: Multiplan Commercial |
$2,000.80
|
| Rate for Payer: Networks By Design Commercial |
$1,625.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.85
|
|
|
HC INJECT/ASPIRATE LIVER CYST
|
Facility
|
OP
|
$5,010.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
909081848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$954.96 |
| Max. Negotiated Rate |
$8,241.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,572.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,258.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,755.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,755.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,006.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cigna of CA PPO |
$3,707.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,258.50
|
| Rate for Payer: Dignity Health Media |
$4,258.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,258.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,004.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,004.00
|
| Rate for Payer: Galaxy Health WC |
$4,258.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,006.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,757.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,341.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$954.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,202.40
|
| Rate for Payer: Multiplan Commercial |
$4,008.00
|
| Rate for Payer: Networks By Design Commercial |
$3,256.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,258.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,006.00
|
| 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 |
$4,258.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,258.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,258.50
|
|
|
HC INJECT/ASPIRATE LIVER CYST
|
Facility
|
IP
|
$5,010.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
909081848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,202.40 |
| Max. Negotiated Rate |
$4,258.50 |
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,004.00
|
| Rate for Payer: Galaxy Health WC |
$4,258.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,006.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,341.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,908.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,202.40
|
| Rate for Payer: Multiplan Commercial |
$4,008.00
|
| Rate for Payer: Networks By Design Commercial |
$3,256.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,258.50
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$346.20
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cigna of CA PPO |
$426.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$490.45
|
| Rate for Payer: Global Benefits Group Commercial |
$346.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$432.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$461.60
|
| Rate for Payer: Networks By Design Commercial |
$375.05
|
| Rate for Payer: Prime Health Services Commercial |
$490.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.50
|
| Rate for Payer: United Healthcare All Other HMO |
$288.50
|
| Rate for Payer: United Healthcare HMO Rider |
$288.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.48 |
| Max. Negotiated Rate |
$490.45 |
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.80
|
| Rate for Payer: Galaxy Health WC |
$490.45
|
| Rate for Payer: Global Benefits Group Commercial |
$346.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.48
|
| Rate for Payer: Multiplan Commercial |
$461.60
|
| Rate for Payer: Networks By Design Commercial |
$375.05
|
| Rate for Payer: Prime Health Services Commercial |
$490.45
|
|
