|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
IP
|
$2,940.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,734.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,911.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
|
|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
OP
|
$2,940.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| 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: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| 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 |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| 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/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| 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 |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,764.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,470.00
|
| 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 |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
IP
|
$3,689.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$737.80 |
| Max. Negotiated Rate |
$3,135.65 |
| Rate for Payer: Networks By Design Commercial |
$2,397.85
|
| Rate for Payer: Adventist Health Commercial |
$737.80
|
| Rate for Payer: Cash Price |
$1,660.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,582.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,475.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,475.60
|
| Rate for Payer: Galaxy Health WC |
$3,135.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,213.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,342.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,176.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$885.36
|
| Rate for Payer: Multiplan Commercial |
$2,951.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,135.65
|
|
|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
OP
|
$3,689.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$369.65 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$737.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| 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: Cash Price |
$1,660.05
|
| Rate for Payer: Cash Price |
$1,660.05
|
| Rate for Payer: Cash Price |
$1,660.05
|
| Rate for Payer: Cigna of CA HMO |
$2,360.96
|
| Rate for Payer: Cigna of CA PPO |
$2,729.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,582.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Galaxy Health WC |
$3,135.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,213.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$369.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,342.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$418.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$885.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,951.20
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,397.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,135.65
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,213.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,844.50
|
| 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 |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| 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 Medi-Cal |
$1,251.34
|
| 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: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| 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 |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| 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/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$263.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| 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: 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 |
$1,470.00
|
| 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 |
$1,137.58
|
| 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 Senior |
$1,137.58
|
|
|
HC INJ INTER LMBR/SAC WO GUID
|
Facility
|
IP
|
$2,940.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,734.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,911.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
|
|
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 |
$902.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,403.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,273.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,182.95
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$401.00
|
| 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 Medi-Cal |
$1,251.34
|
| 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: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$902.25
|
| Rate for Payer: Cash Price |
$902.25
|
| Rate for Payer: Cash Price |
$902.25
|
| 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 |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,403.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| 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/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,273.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$481.20
|
| 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: 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 |
$1,002.50
|
| 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 |
$1,137.58
|
| 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 Senior |
$1,137.58
|
|
|
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 |
$629.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1,027.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,557.36
|
| Rate for Payer: Cash Price |
$1,098.45
|
| Rate for Payer: Cash Price |
$1,098.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,708.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,550.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$886.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,440.19
|
| 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 |
$1,098.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,708.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,550.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,440.19
|
| 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
|
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 |
$1,008.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,568.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,423.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,322.19
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$448.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.84
|
| 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: Cash Price |
$1,008.45
|
| Rate for Payer: Cash Price |
$1,008.45
|
| Rate for Payer: Cash Price |
$1,008.45
|
| 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 |
$1,345.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$986.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$896.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,568.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.79
|
| Rate for Payer: EPIC Health Plan Senior |
$986.52
|
| 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/Senior |
$1,470.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$247.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$896.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,423.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,255.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,130.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.77
|
| 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 |
$1,120.50
|
| 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 |
$896.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Vantage Medical Group Senior |
$896.84
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$191.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| 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: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| 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 |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$668.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$811.75
|
| Rate for Payer: Global Benefits Group Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$606.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| 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 |
$477.50
|
| 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 |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
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 |
$429.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$668.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$606.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$563.45
|
| 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 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 |
$2,198.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,420.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,102.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,882.74
|
| 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 |
$5,641.00 |
| 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 |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cash Price |
$2,198.70
|
| 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 |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,420.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,973.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1,315.69
|
| 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/Senior |
$1,961.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,102.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,285.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,507.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,602.75
|
| 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 |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
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 |
$18.13 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.76
|
| 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 |
$74.02
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$116.20
|
| 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 |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$105.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.94
|
| 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 |
$84.16
|
| Rate for Payer: Blue Shield of California Commercial |
$127.65
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$116.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$105.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.94
|
| 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 TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$1,707.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
902890272
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$699.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$268.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$768.15
|
| Rate for Payer: Cash Price |
$768.15
|
| Rate for Payer: Cash Price |
$768.15
|
| Rate for Payer: Cigna of CA HMO |
$1,092.48
|
| Rate for Payer: Cigna of CA PPO |
$1,263.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,194.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,450.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,024.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,083.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,365.60
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,109.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,450.95
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,024.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,024.20
|
| 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 |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$1,707.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
902890272
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$341.40 |
| Max. Negotiated Rate |
$1,450.95 |
| Rate for Payer: Adventist Health Commercial |
$341.40
|
| Rate for Payer: Cash Price |
$768.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,194.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.80
|
| Rate for Payer: EPIC Health Plan Senior |
$682.80
|
| Rate for Payer: Galaxy Health WC |
$1,450.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,024.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,083.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,007.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.68
|
| Rate for Payer: Multiplan Commercial |
$1,365.60
|
| Rate for Payer: Networks By Design Commercial |
$1,109.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,450.95
|
|
|
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 |
$662.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,030.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$934.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$868.48
|
| 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
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$1,251.20 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,030.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$934.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$868.48
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| 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 |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| 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/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$934.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| 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 |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
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 |
$662.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,030.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$934.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$868.48
|
| 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
|
456
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$603.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$258.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| 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 |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| 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/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$934.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| 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: TriValley Medical Group Commercial/Senior |
$883.20
|
| 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 |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
