|
HC INJ ANES ILIOING ILIOHYPO NRV
|
Facility
|
IP
|
$2,484.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
900100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$496.80 |
| Max. Negotiated Rate |
$2,235.60 |
| Rate for Payer: Adventist Health Commercial |
$496.80
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,987.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,738.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$993.60
|
| Rate for Payer: Galaxy Health WC |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,235.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,577.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,465.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$1,863.00
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
|
|
HC INJ ANES LUMBAR OR THORACIC
|
Facility
|
OP
|
$3,286.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
900100639
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$657.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,137.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,478.70
|
| Rate for Payer: Cash Price |
$1,478.70
|
| Rate for Payer: Cash Price |
$1,478.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,628.80
|
| Rate for Payer: Cigna of CA HMO |
$2,103.04
|
| Rate for Payer: Cigna of CA PPO |
$2,431.64
|
| 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 |
$2,300.20
|
| 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 |
$2,793.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,971.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,957.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$144.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,086.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,464.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,135.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,793.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,971.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,643.00
|
| 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 ANES LUMBAR OR THORACIC
|
Facility
|
IP
|
$3,286.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
900100639
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$657.20 |
| Max. Negotiated Rate |
$2,957.40 |
| Rate for Payer: Adventist Health Commercial |
$657.20
|
| Rate for Payer: Cash Price |
$1,478.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,628.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,300.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,314.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,314.40
|
| Rate for Payer: Galaxy Health WC |
$2,793.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,971.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,957.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,086.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,938.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.20
|
| Rate for Payer: Multiplan Commercial |
$2,464.50
|
| Rate for Payer: Networks By Design Commercial |
$2,135.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,793.10
|
|
|
HC INJ ANES STELLATE GANGLION
|
Facility
|
IP
|
$2,471.00
|
|
|
Service Code
|
CPT 64510
|
| Hospital Charge Code |
900100638
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$494.20 |
| Max. Negotiated Rate |
$2,223.90 |
| Rate for Payer: Adventist Health Commercial |
$494.20
|
| Rate for Payer: Cash Price |
$1,111.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,976.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,729.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$988.40
|
| Rate for Payer: EPIC Health Plan Senior |
$988.40
|
| Rate for Payer: Galaxy Health WC |
$2,100.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,482.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,223.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,569.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,457.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.20
|
| Rate for Payer: Multiplan Commercial |
$1,853.25
|
| Rate for Payer: Networks By Design Commercial |
$1,606.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,100.35
|
|
|
HC INJ ANES STELLATE GANGLION
|
Facility
|
OP
|
$2,471.00
|
|
|
Service Code
|
CPT 64510
|
| Hospital Charge Code |
900100638
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$494.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,137.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,566.61
|
| Rate for Payer: Blue Shield of California EPN |
$985.93
|
| Rate for Payer: Cash Price |
$1,111.95
|
| Rate for Payer: Cash Price |
$1,111.95
|
| Rate for Payer: Cash Price |
$1,111.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,976.80
|
| Rate for Payer: Cigna of CA HMO |
$1,581.44
|
| Rate for Payer: Cigna of CA PPO |
$1,828.54
|
| 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 |
$1,729.70
|
| 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 |
$2,100.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,482.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,223.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$104.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,569.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$1,853.25
|
| Rate for Payer: Networks By Design Commercial |
$1,606.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Prime Health Services Commercial |
$2,100.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,482.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,482.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,235.50
|
| 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 ANSTC AGT SPR HYPGTRC PLXS
|
Facility
|
OP
|
$3,286.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
909004517
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$657.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,137.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,478.70
|
| Rate for Payer: Cash Price |
$1,478.70
|
| Rate for Payer: Cash Price |
$1,478.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,628.80
|
| Rate for Payer: Cigna of CA HMO |
$2,103.04
|
| Rate for Payer: Cigna of CA PPO |
$2,431.64
|
| 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 |
$2,300.20
|
| 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 |
$2,793.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,971.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,957.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$272.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,086.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$300.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,464.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,135.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,793.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,971.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,643.00
|
| 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 ANSTC AGT SPR HYPGTRC PLXS
|
Facility
|
IP
|
$3,286.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
909004517
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$657.20 |
| Max. Negotiated Rate |
$2,957.40 |
| Rate for Payer: Adventist Health Commercial |
$657.20
|
| Rate for Payer: Cash Price |
$1,478.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,628.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,300.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,314.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,314.40
|
| Rate for Payer: Galaxy Health WC |
$2,793.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,971.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,957.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,086.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,938.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.20
|
| Rate for Payer: Multiplan Commercial |
$2,464.50
|
| Rate for Payer: Networks By Design Commercial |
$2,135.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,793.10
|
|
|
HC INJ ANTGRD NEPH AND OR URETER
|
Facility
|
IP
|
$2,578.00
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
909050430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.60 |
| Max. Negotiated Rate |
$2,320.20 |
| Rate for Payer: Adventist Health Commercial |
$515.60
|
| Rate for Payer: Cash Price |
$1,160.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,062.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,804.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,031.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,031.20
|
| Rate for Payer: Galaxy Health WC |
$2,191.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,546.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,320.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,637.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,521.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.60
|
| Rate for Payer: Multiplan Commercial |
$1,933.50
|
| Rate for Payer: Networks By Design Commercial |
$1,675.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,191.30
|
|
|
HC INJ ANTGRD NEPH AND OR URETER
|
Facility
|
OP
|
$2,578.00
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
909050430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$515.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$896.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,351.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,160.10
|
| Rate for Payer: Cash Price |
$1,160.10
|
| Rate for Payer: Cash Price |
$1,160.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,062.40
|
| Rate for Payer: Cigna of CA HMO |
$1,649.92
|
| Rate for Payer: Cigna of CA PPO |
$1,907.72
|
| 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 |
$1,804.60
|
| 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 |
$2,191.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,546.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,320.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,470.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$817.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$896.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,637.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$902.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,255.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,201.77
|
| Rate for Payer: Multiplan Commercial |
$1,933.50
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$1,675.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$896.84
|
| Rate for Payer: Preferred Health Network WC |
$1,378.84
|
| Rate for Payer: Prime Health Services Commercial |
$2,191.30
|
| Rate for Payer: Prime Health Services Medicare |
$950.65
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Riverside University Health System MISP |
$986.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,546.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,289.00
|
| 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 |
$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 CNTRST KNEE ARTHG CT MRI
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$612.90 |
| Rate for Payer: Adventist Health Commercial |
$136.20
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Central Health Plan Commercial |
$544.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.40
|
| Rate for Payer: EPIC Health Plan Senior |
$272.40
|
| Rate for Payer: Galaxy Health WC |
$578.85
|
| Rate for Payer: Global Benefits Group Commercial |
$408.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$432.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$401.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.20
|
| Rate for Payer: Multiplan Commercial |
$510.75
|
| Rate for Payer: Networks By Design Commercial |
$442.65
|
| Rate for Payer: Prime Health Services Commercial |
$578.85
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$136.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$578.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$374.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Central Health Plan Commercial |
$544.80
|
| Rate for Payer: Cigna of CA HMO |
$435.84
|
| Rate for Payer: Cigna of CA PPO |
$503.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$578.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$578.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$578.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.40
|
| Rate for Payer: EPIC Health Plan Senior |
$272.40
|
| Rate for Payer: Galaxy Health WC |
$578.85
|
| Rate for Payer: Global Benefits Group Commercial |
$408.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$432.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$401.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$476.70
|
| Rate for Payer: Multiplan Commercial |
$510.75
|
| Rate for Payer: Networks By Design Commercial |
$442.65
|
| Rate for Payer: Prime Health Services Commercial |
$578.85
|
| Rate for Payer: Riverside University Health System MISP |
$272.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.50
|
| Rate for Payer: United Healthcare All Other HMO |
$340.50
|
| Rate for Payer: United Healthcare HMO Rider |
$340.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$578.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$578.85
|
| Rate for Payer: Vantage Medical Group Senior |
$578.85
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$136.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$578.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$374.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Central Health Plan Commercial |
$544.80
|
| Rate for Payer: Cigna of CA HMO |
$435.84
|
| Rate for Payer: Cigna of CA PPO |
$503.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$578.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$578.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$578.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.40
|
| Rate for Payer: EPIC Health Plan Senior |
$272.40
|
| Rate for Payer: Galaxy Health WC |
$578.85
|
| Rate for Payer: Global Benefits Group Commercial |
$408.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$224.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$432.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$401.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$476.70
|
| Rate for Payer: Multiplan Commercial |
$510.75
|
| Rate for Payer: Networks By Design Commercial |
$442.65
|
| Rate for Payer: Prime Health Services Commercial |
$578.85
|
| Rate for Payer: Riverside University Health System MISP |
$272.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.50
|
| 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: Vantage Medical Group Commercial/Exchange |
$578.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$578.85
|
| Rate for Payer: Vantage Medical Group Senior |
$578.85
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$612.90 |
| Rate for Payer: Adventist Health Commercial |
$136.20
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Central Health Plan Commercial |
$544.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.40
|
| Rate for Payer: EPIC Health Plan Senior |
$272.40
|
| Rate for Payer: Galaxy Health WC |
$578.85
|
| Rate for Payer: Global Benefits Group Commercial |
$408.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$432.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$401.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.20
|
| Rate for Payer: Multiplan Commercial |
$510.75
|
| Rate for Payer: Networks By Design Commercial |
$442.65
|
| Rate for Payer: Prime Health Services Commercial |
$578.85
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
|
IP
|
$3,835.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906811575
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$3,451.50 |
| Rate for Payer: Adventist Health Commercial |
$767.00
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,068.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,684.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,534.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,534.00
|
| Rate for Payer: Galaxy Health WC |
$3,259.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,301.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,451.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,435.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,262.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.00
|
| Rate for Payer: Multiplan Commercial |
$2,876.25
|
| Rate for Payer: Networks By Design Commercial |
$2,492.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,259.75
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
|
OP
|
$3,835.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906811575
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$524.91 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$767.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$524.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,259.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,109.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,876.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,856.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,230.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,068.00
|
| Rate for Payer: Cigna of CA HMO |
$2,454.40
|
| Rate for Payer: Cigna of CA PPO |
$2,837.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,259.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,259.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,259.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,684.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,534.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,534.00
|
| Rate for Payer: Galaxy Health WC |
$3,259.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,301.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,451.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,435.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,262.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,684.50
|
| Rate for Payer: Multiplan Commercial |
$2,876.25
|
| Rate for Payer: Networks By Design Commercial |
$2,492.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,259.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,534.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,301.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,301.00
|
| 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 |
$3,259.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,259.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,259.75
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
OP
|
$3,835.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906811573
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$355.32 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$767.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$355.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,259.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,109.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,876.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,856.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,230.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,068.00
|
| Rate for Payer: Cigna of CA HMO |
$2,454.40
|
| Rate for Payer: Cigna of CA PPO |
$2,837.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,259.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,259.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,259.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,684.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,534.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,534.00
|
| Rate for Payer: Galaxy Health WC |
$3,259.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,301.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,451.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,435.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,262.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,684.50
|
| Rate for Payer: Multiplan Commercial |
$2,876.25
|
| Rate for Payer: Networks By Design Commercial |
$2,492.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,259.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,534.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,301.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,301.00
|
| 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 |
$3,259.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,259.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,259.75
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
IP
|
$3,835.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906811573
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$3,451.50 |
| Rate for Payer: Adventist Health Commercial |
$767.00
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,068.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,684.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,534.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,534.00
|
| Rate for Payer: Galaxy Health WC |
$3,259.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,301.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,451.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,435.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,262.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.00
|
| Rate for Payer: Multiplan Commercial |
$2,876.25
|
| Rate for Payer: Networks By Design Commercial |
$2,492.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,259.75
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
IP
|
$3,835.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906811569
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$3,451.50 |
| Rate for Payer: Adventist Health Commercial |
$767.00
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,068.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,684.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,534.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,534.00
|
| Rate for Payer: Galaxy Health WC |
$3,259.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,301.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,451.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,435.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,262.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.00
|
| Rate for Payer: Multiplan Commercial |
$2,876.25
|
| Rate for Payer: Networks By Design Commercial |
$2,492.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,259.75
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
OP
|
$3,835.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906811569
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$213.15 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$767.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,259.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,109.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,876.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,856.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,230.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,068.00
|
| Rate for Payer: Cigna of CA HMO |
$2,454.40
|
| Rate for Payer: Cigna of CA PPO |
$2,837.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,259.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,259.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,259.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,684.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,534.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,534.00
|
| Rate for Payer: Galaxy Health WC |
$3,259.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,301.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,451.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,435.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,262.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,684.50
|
| Rate for Payer: Multiplan Commercial |
$2,876.25
|
| Rate for Payer: Networks By Design Commercial |
$2,492.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,259.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,534.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,301.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,301.00
|
| 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 |
$3,259.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,259.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,259.75
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
|
OP
|
$3,835.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906811574
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$392.50 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$767.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$392.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,259.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,109.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,876.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,856.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,230.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,068.00
|
| Rate for Payer: Cigna of CA HMO |
$2,454.40
|
| Rate for Payer: Cigna of CA PPO |
$2,837.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,259.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,259.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,259.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,684.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,534.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,534.00
|
| Rate for Payer: Galaxy Health WC |
$3,259.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,301.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,451.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,435.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,262.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,684.50
|
| Rate for Payer: Multiplan Commercial |
$2,876.25
|
| Rate for Payer: Networks By Design Commercial |
$2,492.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,259.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,534.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,301.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,301.00
|
| 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 |
$3,259.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,259.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,259.75
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
|
IP
|
$3,835.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906811574
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$3,451.50 |
| Rate for Payer: Adventist Health Commercial |
$767.00
|
| Rate for Payer: Cash Price |
$1,725.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,068.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,684.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,534.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,534.00
|
| Rate for Payer: Galaxy Health WC |
$3,259.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,301.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,451.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,435.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,262.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.00
|
| Rate for Payer: Multiplan Commercial |
$2,876.25
|
| Rate for Payer: Networks By Design Commercial |
$2,492.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,259.75
|
|
|
HC INJ CRV/THRC INC CATH W GUID
|
Facility
|
OP
|
$4,815.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
907262325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$336.19 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$963.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,137.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,166.75
|
| Rate for Payer: Cash Price |
$2,166.75
|
| Rate for Payer: Cash Price |
$2,166.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,852.00
|
| Rate for Payer: Cigna of CA HMO |
$3,081.60
|
| Rate for Payer: Cigna of CA PPO |
$3,563.10
|
| 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 |
$3,370.50
|
| 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 |
$4,092.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,889.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,333.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$336.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,057.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$963.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$3,611.25
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$3,129.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,092.75
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,889.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,407.50
|
| 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 CRV/THRC INC CATH W GUID
|
Facility
|
IP
|
$4,815.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
907262325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$963.00 |
| Max. Negotiated Rate |
$4,333.50 |
| Rate for Payer: Adventist Health Commercial |
$963.00
|
| Rate for Payer: Cash Price |
$2,166.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,852.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,370.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,926.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,926.00
|
| Rate for Payer: Galaxy Health WC |
$4,092.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,889.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,333.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,057.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,840.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$963.00
|
| Rate for Payer: Multiplan Commercial |
$3,611.25
|
| Rate for Payer: Networks By Design Commercial |
$3,129.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,092.75
|
|
|
HC INJ CRV/THRC INC CATH WO GUID
|
Facility
|
IP
|
$4,377.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
907262324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$875.40 |
| Max. Negotiated Rate |
$3,939.30 |
| Rate for Payer: Adventist Health Commercial |
$875.40
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,501.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,063.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,750.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,750.80
|
| Rate for Payer: Galaxy Health WC |
$3,720.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,626.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,939.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,779.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,582.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.40
|
| Rate for Payer: Multiplan Commercial |
$3,282.75
|
| Rate for Payer: Networks By Design Commercial |
$2,845.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,720.45
|
|
|
HC INJ CRV/THRC INC CATH WO GUID
|
Facility
|
OP
|
$4,377.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
907262324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$219.01 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$875.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,137.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,501.60
|
| Rate for Payer: Cigna of CA HMO |
$2,801.28
|
| Rate for Payer: Cigna of CA PPO |
$3,238.98
|
| 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 |
$3,063.90
|
| 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 |
$3,720.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,626.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,939.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$219.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,779.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$3,282.75
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,845.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,720.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,626.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,188.50
|
| 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
|
|
