|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cigna of CA HMO |
$321.92
|
| Rate for Payer: Cigna of CA PPO |
$372.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.10
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.10
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.50
|
| Rate for Payer: United Healthcare All Other HMO |
$251.50
|
| Rate for Payer: United Healthcare HMO Rider |
$251.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.55
|
| Rate for Payer: Vantage Medical Group Senior |
$427.55
|
|
|
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 |
$594.76 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$594.76
|
| 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 |
$2,979.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,250.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,948.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,739.37
|
| 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 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 |
$2,089.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,250.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,948.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,739.37
|
| 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
|
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 |
$2,089.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,250.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,948.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,739.37
|
| 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
|
$4,643.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906811573
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$402.60 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$402.60
|
| 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 |
$2,979.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,250.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,948.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,739.37
|
| 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 |
$2,089.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,250.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,948.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,739.37
|
| 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
|
OP
|
$4,643.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906811569
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$241.52 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$241.52
|
| 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 |
$2,979.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,250.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,948.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,739.37
|
| 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
|
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 |
$2,089.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,250.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,948.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,739.37
|
| 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 |
$444.73 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$444.73
|
| 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 |
$2,979.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,250.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,948.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,739.37
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$489.00
|
| Rate for Payer: Adventist Health Commercial |
$365.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cigna of CA HMO |
$1,169.28
|
| Rate for Payer: Cigna of CA HMO |
$1,564.80
|
| Rate for Payer: Cigna of CA PPO |
$1,809.30
|
| Rate for Payer: Cigna of CA PPO |
$1,351.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,278.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,711.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Galaxy Health WC |
$1,552.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,096.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$235.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$235.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,552.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,160.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$1,461.60
|
| Rate for Payer: Multiplan Commercial |
$1,956.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Networks By Design Commercial |
$1,187.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,552.95
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$1,096.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,222.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$913.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| 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 HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$489.00
|
| Rate for Payer: Adventist Health Commercial |
$365.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cigna of CA HMO |
$1,564.80
|
| Rate for Payer: Cigna of CA HMO |
$1,169.28
|
| Rate for Payer: Cigna of CA PPO |
$1,351.98
|
| Rate for Payer: Cigna of CA PPO |
$1,809.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,711.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,278.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Galaxy Health WC |
$1,552.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,096.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$235.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$235.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,552.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,160.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$1,461.60
|
| Rate for Payer: Multiplan Commercial |
$1,956.00
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Networks By Design Commercial |
$1,187.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,552.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,467.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,096.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,365.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,365.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$913.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,222.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| 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 HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
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 |
$1,100.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,711.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,552.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,442.55
|
| 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 |
$1,100.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,711.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,552.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,442.55
|
| 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/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 |
$1,916.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,980.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,703.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,512.22
|
| 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 |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,916.10
|
| Rate for Payer: Cash Price |
$1,916.10
|
| Rate for Payer: Cash Price |
$1,916.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,980.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,703.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$954.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,512.22
|
| 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 |
$2,129.00
|
| 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
|
IP
|
$490.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$416.50 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Networks By Design Commercial |
$318.50
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$200.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$197.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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: TriValley Medical Group Commercial/Senior |
$294.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$416.50 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Networks By Design Commercial |
$318.50
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC INJECTION ADMIN SYNAGIS
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
912190471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$62.05 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.20
|
| Rate for Payer: EPIC Health Plan Senior |
$29.20
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
|
|
HC INJECTION ADMIN SYNAGIS
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
912190471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$152.79 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.84
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.50
|
| Rate for Payer: United Healthcare All Other HMO |
$36.50
|
| Rate for Payer: United Healthcare HMO Rider |
$36.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC INJECTION EYE DRUG
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
900501532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.20 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cigna of CA HMO |
$883.84
|
| Rate for Payer: Cigna of CA PPO |
$1,021.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$966.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$876.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$691.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$535.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,104.80
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$828.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$690.50
|
| Rate for Payer: United Healthcare All Other HMO |
$690.50
|
| Rate for Payer: United Healthcare HMO Rider |
$690.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$690.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC INJECTION EYE DRUG
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
900501532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.20 |
| Max. Negotiated Rate |
$1,173.85 |
| Rate for Payer: EPIC Health Plan Commercial |
$552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$552.40
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$966.70
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$876.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$814.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.44
|
| Rate for Payer: Multiplan Commercial |
$1,104.80
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
|
|
HC INJECTION FACIAL NERVE
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
900501174
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$393.12 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$671.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,074.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,392.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$900.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,228.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cigna of CA HMO |
$1,048.32
|
| Rate for Payer: Cigna of CA PPO |
$1,212.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,392.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,392.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,392.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,146.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$655.20
|
| Rate for Payer: EPIC Health Plan Senior |
$655.20
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,040.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$594.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$966.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,146.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,146.60
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$982.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$982.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,392.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,392.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,392.30
|
|
|
HC INJECTION FACIAL NERVE
|
Facility
|
IP
|
$1,638.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
900501174
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Adventist Health Commercial |
$327.60
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,146.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$655.20
|
| Rate for Payer: EPIC Health Plan Senior |
$655.20
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,040.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$966.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.12
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
|
