|
HC INJ INTER LMBR/SAC WO GUID
|
Facility
|
OP
|
$2,940.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.68 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| 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 |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna of CA HMO |
$1,881.60
|
| Rate for Payer: Cigna of CA PPO |
$2,175.60
|
| 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 |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| 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 |
$2,352.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,911.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,764.00
|
| 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 INJ NEURO SUB W WO THRPTC SUB EPDRL, LMBR, SCRL
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
909000282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$225.79 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$401.00
|
| 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 |
$1,102.75
|
| Rate for Payer: Cash Price |
$1,102.75
|
| Rate for Payer: Cash Price |
$1,102.75
|
| Rate for Payer: Cigna of CA HMO |
$1,283.20
|
| Rate for Payer: Cigna of CA PPO |
$1,483.70
|
| 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 |
$1,704.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,203.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,337.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$481.20
|
| 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 |
$1,604.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,303.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,704.25
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,203.00
|
| 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 INJ NEURO SUB W WO THRPTC SUB EPDRL, LMBR, SCRL
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
909000282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$401.00 |
| Max. Negotiated Rate |
$1,704.25 |
| Rate for Payer: Adventist Health Commercial |
$401.00
|
| Rate for Payer: Cash Price |
$1,102.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$802.00
|
| Rate for Payer: EPIC Health Plan Senior |
$802.00
|
| Rate for Payer: Galaxy Health WC |
$1,704.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,337.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$763.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,241.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$481.20
|
| Rate for Payer: Multiplan Commercial |
$1,604.00
|
| Rate for Payer: Networks By Design Commercial |
$1,303.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,704.25
|
|
|
HC INJ OF ANESTHETIC/ANTIPASMODE
|
Facility
|
OP
|
$2,441.00
|
|
|
Service Code
|
CPT 72275
|
| Hospital Charge Code |
909001356
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$488.20 |
| Max. Negotiated Rate |
$2,074.85 |
| Rate for Payer: Adventist Health Commercial |
$488.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,601.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,074.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,342.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,830.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$602.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,493.89
|
| Rate for Payer: Blue Shield of California EPN |
$986.16
|
| Rate for Payer: Cash Price |
$1,342.55
|
| Rate for Payer: Cash Price |
$1,342.55
|
| Rate for Payer: Cigna of CA HMO |
$1,562.24
|
| Rate for Payer: Cigna of CA PPO |
$1,806.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,074.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,074.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,074.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$976.40
|
| Rate for Payer: EPIC Health Plan Senior |
$976.40
|
| Rate for Payer: Galaxy Health WC |
$2,074.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,464.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,628.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$930.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,510.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,708.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,708.70
|
| Rate for Payer: Multiplan Commercial |
$1,952.80
|
| Rate for Payer: Networks By Design Commercial |
$1,586.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,074.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,464.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,464.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,220.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,220.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,220.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,220.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,074.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,074.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,074.85
|
|
|
HC INJ OF ANESTHETIC/ANTIPASMODE
|
Facility
|
IP
|
$2,441.00
|
|
|
Service Code
|
CPT 72275
|
| Hospital Charge Code |
909001356
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$488.20 |
| Max. Negotiated Rate |
$2,074.85 |
| Rate for Payer: Adventist Health Commercial |
$488.20
|
| Rate for Payer: Cash Price |
$1,342.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$976.40
|
| Rate for Payer: EPIC Health Plan Senior |
$976.40
|
| Rate for Payer: Galaxy Health WC |
$2,074.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,464.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,628.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$930.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,510.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.84
|
| Rate for Payer: Multiplan Commercial |
$1,952.80
|
| Rate for Payer: Networks By Design Commercial |
$1,586.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,074.85
|
|
|
HC INJ PROC FOR NEPH LOOP STENT GRAM
|
Facility
|
OP
|
$2,241.00
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
909000167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.06 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$448.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| 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 |
$1,232.55
|
| Rate for Payer: Cash Price |
$1,232.55
|
| Rate for Payer: Cash Price |
$1,232.55
|
| Rate for Payer: Cigna of CA HMO |
$1,434.24
|
| Rate for Payer: Cigna of CA PPO |
$1,658.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.92
|
| Rate for Payer: EPIC Health Plan Senior |
$848.09
|
| Rate for Payer: Galaxy Health WC |
$1,904.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,344.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,390.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$247.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,494.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,136.44
|
| Rate for Payer: Multiplan Commercial |
$1,792.80
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$1,456.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,904.85
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,344.60
|
| 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 |
$848.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
|
HC INJ PROC FOR NEPH LOOP STENT GRAM
|
Facility
|
IP
|
$2,241.00
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
909000167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$448.20 |
| Max. Negotiated Rate |
$1,904.85 |
| Rate for Payer: Adventist Health Commercial |
$448.20
|
| Rate for Payer: Cash Price |
$1,232.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$896.40
|
| Rate for Payer: EPIC Health Plan Senior |
$896.40
|
| Rate for Payer: Galaxy Health WC |
$1,904.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,344.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,494.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,387.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.84
|
| Rate for Payer: Multiplan Commercial |
$1,792.80
|
| Rate for Payer: Networks By Design Commercial |
$1,456.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,904.85
|
|
|
HC INJ SCLEROSING SOL SINGLE VEIN
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
909036470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$191.00 |
| Max. Negotiated Rate |
$811.75 |
| Rate for Payer: Adventist Health Commercial |
$191.00
|
| Rate for Payer: Cash Price |
$525.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.00
|
| Rate for Payer: EPIC Health Plan Senior |
$382.00
|
| Rate for Payer: Galaxy Health WC |
$811.75
|
| Rate for Payer: Global Benefits Group Commercial |
$573.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$636.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$591.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.20
|
| Rate for Payer: Multiplan Commercial |
$764.00
|
| Rate for Payer: Networks By Design Commercial |
$620.75
|
| Rate for Payer: Prime Health Services Commercial |
$811.75
|
|
|
HC INJ SCLEROSING SOL SINGLE VEIN
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
909036470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.22 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$191.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| 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 |
$525.25
|
| Rate for Payer: Cash Price |
$525.25
|
| Rate for Payer: Cash Price |
$525.25
|
| Rate for Payer: Cigna of CA HMO |
$611.20
|
| Rate for Payer: Cigna of CA PPO |
$706.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$811.75
|
| Rate for Payer: Global Benefits Group Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$636.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$764.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$620.75
|
| Rate for Payer: Prime Health Services Commercial |
$811.75
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC INJ SCLEROSING SOLUTION HEMORR
|
Facility
|
IP
|
$4,886.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
900501731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$977.20 |
| Max. Negotiated Rate |
$4,153.10 |
| Rate for Payer: Adventist Health Commercial |
$977.20
|
| Rate for Payer: Cash Price |
$2,687.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,954.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,954.40
|
| Rate for Payer: Galaxy Health WC |
$4,153.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,931.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,258.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,861.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,024.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.64
|
| Rate for Payer: Multiplan Commercial |
$3,908.80
|
| Rate for Payer: Networks By Design Commercial |
$3,175.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,153.10
|
|
|
HC INJ SCLEROSING SOLUTION HEMORR
|
Facility
|
OP
|
$4,886.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
900501731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$977.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,687.30
|
| Rate for Payer: Cash Price |
$2,687.30
|
| Rate for Payer: Cash Price |
$2,687.30
|
| Rate for Payer: Cigna of CA HMO |
$3,127.04
|
| Rate for Payer: Cigna of CA PPO |
$3,615.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$4,153.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,931.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,258.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$3,908.80
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: Networks By Design Commercial |
$3,175.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,153.10
|
| Rate for Payer: Prime Health Services WC |
$1,826.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,931.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,443.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,443.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,443.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,443.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC INJ SULFUR HEXA LUMASON PER ML
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT Q9950
|
| Hospital Charge Code |
906609950
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.19
|
| Rate for Payer: Cash Price |
$91.30
|
| Rate for Payer: Cash Price |
$91.30
|
| Rate for Payer: Cigna of CA HMO |
$106.24
|
| Rate for Payer: Cigna of CA PPO |
$122.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$116.20
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.00
|
| Rate for Payer: United Healthcare All Other HMO |
$83.00
|
| Rate for Payer: United Healthcare HMO Rider |
$83.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC INJ SULFUR HEXA LUMASON PER ML
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT Q9950
|
| Hospital Charge Code |
906609950
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Blue Shield of California Commercial |
$122.51
|
| Rate for Payer: Blue Shield of California EPN |
$80.68
|
| Rate for Payer: Cash Price |
$91.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.84
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$1,251.20 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$981.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$911.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: Networks By Design Commercial |
$956.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$942.08
|
| Rate for Payer: Cigna of CA PPO |
$1,089.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$981.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$956.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$736.00
|
| Rate for Payer: United Healthcare All Other HMO |
$736.00
|
| Rate for Payer: United Healthcare HMO Rider |
$736.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$736.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| 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 |
$570.02
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$942.08
|
| Rate for Payer: Cigna of CA PPO |
$1,089.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$981.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$956.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$1,251.20 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$981.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$911.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: Networks By Design Commercial |
$956.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
OP
|
$1,635.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.45 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| 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 |
$570.02
|
| Rate for Payer: Cash Price |
$899.25
|
| Rate for Payer: Cash Price |
$899.25
|
| Rate for Payer: Cash Price |
$899.25
|
| Rate for Payer: Cigna of CA HMO |
$1,046.40
|
| Rate for Payer: Cigna of CA PPO |
$1,209.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,090.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$981.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
OP
|
$1,635.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.45 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,000.62
|
| Rate for Payer: Blue Shield of California EPN |
$660.54
|
| Rate for Payer: Cash Price |
$899.25
|
| Rate for Payer: Cash Price |
$899.25
|
| Rate for Payer: Cash Price |
$899.25
|
| Rate for Payer: Cigna of CA HMO |
$1,046.40
|
| Rate for Payer: Cigna of CA PPO |
$1,209.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,090.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$981.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$981.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.50
|
| Rate for Payer: United Healthcare All Other HMO |
$817.50
|
| Rate for Payer: United Healthcare HMO Rider |
$817.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$817.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
IP
|
$1,635.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$1,389.75 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Cash Price |
$899.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.00
|
| Rate for Payer: EPIC Health Plan Senior |
$654.00
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,090.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,012.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
IP
|
$1,635.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$1,389.75 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Cash Price |
$899.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.00
|
| Rate for Payer: EPIC Health Plan Senior |
$654.00
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,090.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,012.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$342.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$466.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| 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 |
$342.10
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Cigna of CA HMO |
$398.08
|
| Rate for Payer: Cigna of CA PPO |
$460.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$528.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$528.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$482.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$385.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$435.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.40
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$373.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.70
|
| Rate for Payer: Vantage Medical Group Senior |
$528.70
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$342.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$466.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$380.66
|
| Rate for Payer: Blue Shield of California EPN |
$251.29
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Cigna of CA HMO |
$398.08
|
| Rate for Payer: Cigna of CA PPO |
$460.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$528.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$528.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$482.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$385.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$435.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.40
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$373.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$373.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$311.00
|
| Rate for Payer: United Healthcare All Other HMO |
$311.00
|
| Rate for Payer: United Healthcare HMO Rider |
$311.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$311.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.70
|
| Rate for Payer: Vantage Medical Group Senior |
$528.70
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$528.70 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$385.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.28
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$528.70 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$385.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.28
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
|
