|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$427.55 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$427.55 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906820298
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$902.40 |
| Max. Negotiated Rate |
$3,835.20 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906820298
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,959.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,481.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,770.82
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cigna of CA HMO |
$2,887.68
|
| Rate for Payer: Cigna of CA PPO |
$3,338.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,835.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,158.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,158.40
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,707.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,707.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
|
IP
|
$4,643.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906811575
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$928.60 |
| Max. Negotiated Rate |
$3,946.55 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,768.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
|
OP
|
$4,643.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906811575
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,045.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,553.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,482.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,851.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: Cigna of CA HMO |
$2,971.52
|
| Rate for Payer: Cigna of CA PPO |
$3,435.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,946.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,946.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,250.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,250.10
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,785.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,785.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
IP
|
$4,643.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906811573
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$928.60 |
| Max. Negotiated Rate |
$3,946.55 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,768.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906820296
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,959.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,481.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,770.82
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cigna of CA HMO |
$2,887.68
|
| Rate for Payer: Cigna of CA PPO |
$3,338.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,835.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,158.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,158.40
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,707.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,707.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906820296
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$902.40 |
| Max. Negotiated Rate |
$3,835.20 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
OP
|
$4,643.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906811573
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,045.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,553.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,482.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,851.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: Cigna of CA HMO |
$2,971.52
|
| Rate for Payer: Cigna of CA PPO |
$3,435.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,946.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,946.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,250.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,250.10
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,785.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,785.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
OP
|
$4,643.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906811569
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,045.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,553.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,482.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,851.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: Cigna of CA HMO |
$2,971.52
|
| Rate for Payer: Cigna of CA PPO |
$3,435.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,946.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,946.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,250.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,250.10
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,785.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,785.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
IP
|
$4,643.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906811569
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$928.60 |
| Max. Negotiated Rate |
$3,946.55 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,768.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906820295
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$902.40 |
| Max. Negotiated Rate |
$3,835.20 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906820295
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,959.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,481.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,770.82
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cigna of CA HMO |
$2,887.68
|
| Rate for Payer: Cigna of CA PPO |
$3,338.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,835.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,158.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,158.40
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,707.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,707.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906820297
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$902.40 |
| Max. Negotiated Rate |
$3,835.20 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
|
IP
|
$4,643.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906811574
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$928.60 |
| Max. Negotiated Rate |
$3,946.55 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,768.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
|
OP
|
$4,643.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906811574
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,045.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,553.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,482.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,851.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: Cigna of CA HMO |
$2,971.52
|
| Rate for Payer: Cigna of CA PPO |
$3,435.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,946.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,946.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,250.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,250.10
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,785.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,785.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906820297
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,959.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,481.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,770.82
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cigna of CA HMO |
$2,887.68
|
| Rate for Payer: Cigna of CA PPO |
$3,338.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,835.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,158.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,158.40
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,707.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,707.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,835.20
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
IP
|
$2,445.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$489.00 |
| Max. Negotiated Rate |
$2,078.25 |
| Rate for Payer: Adventist Health Commercial |
$489.00
|
| Rate for Payer: Cash Price |
$1,344.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$978.00
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,630.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,513.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.80
|
| Rate for Payer: Multiplan Commercial |
$1,956.00
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
IP
|
$2,445.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$489.00 |
| Max. Negotiated Rate |
$2,078.25 |
| Rate for Payer: Adventist Health Commercial |
$489.00
|
| Rate for Payer: Cash Price |
$1,344.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$978.00
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,630.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,513.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.80
|
| Rate for Payer: Multiplan Commercial |
$1,956.00
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
OP
|
$2,445.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$235.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$489.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,344.75
|
| Rate for Payer: Cash Price |
$1,344.75
|
| Rate for Payer: Cash Price |
$1,344.75
|
| Rate for Payer: Cigna of CA HMO |
$1,564.80
|
| Rate for Payer: Cigna of CA PPO |
$1,809.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$235.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,630.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$1,956.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,467.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
OP
|
$2,445.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$235.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$489.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,344.75
|
| Rate for Payer: Cash Price |
$1,344.75
|
| Rate for Payer: Cash Price |
$1,344.75
|
| Rate for Payer: Cigna of CA HMO |
$1,564.80
|
| Rate for Payer: Cigna of CA PPO |
$1,809.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$235.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,630.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$1,956.00
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,467.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,357.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJECT/ASPIRATE LIVER CYST
|
Facility
|
IP
|
$4,258.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
909081848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$851.60 |
| Max. Negotiated Rate |
$3,619.30 |
| Rate for Payer: Adventist Health Commercial |
$851.60
|
| Rate for Payer: Cash Price |
$2,341.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,703.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,703.20
|
| Rate for Payer: Galaxy Health WC |
$3,619.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,554.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,840.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,622.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,635.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.92
|
| Rate for Payer: Multiplan Commercial |
$3,406.40
|
| Rate for Payer: Networks By Design Commercial |
$2,767.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,619.30
|
|
|
HC INJECT/ASPIRATE LIVER CYST
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
909081848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$844.38 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$851.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,619.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,341.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,193.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,341.90
|
| Rate for Payer: Cash Price |
$2,341.90
|
| Rate for Payer: Cash Price |
$2,341.90
|
| Rate for Payer: Cigna of CA HMO |
$2,725.12
|
| Rate for Payer: Cigna of CA PPO |
$3,150.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,619.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,619.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,619.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,703.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,703.20
|
| Rate for Payer: Galaxy Health WC |
$3,619.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,554.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$844.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,840.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$954.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,635.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,980.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,980.60
|
| Rate for Payer: Multiplan Commercial |
$3,406.40
|
| Rate for Payer: Networks By Design Commercial |
$2,767.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,619.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,554.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,619.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,619.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,619.30
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cigna of CA HMO |
$313.60
|
| Rate for Payer: Cigna of CA PPO |
$362.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$326.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$318.50
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.00
|
| Rate for Payer: United Healthcare All Other HMO |
$245.00
|
| Rate for Payer: United Healthcare HMO Rider |
$245.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$245.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
