|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
OP
|
$4,991.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$378.45 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$998.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$907.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 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 |
$1,402.00
|
| 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 |
$2,245.95
|
| Rate for Payer: Cash Price |
$2,245.95
|
| Rate for Payer: Cash Price |
$2,245.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,992.80
|
| Rate for Payer: Cigna of CA HMO |
$3,194.24
|
| Rate for Payer: Cigna of CA PPO |
$3,693.34
|
| 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 |
$3,493.70
|
| 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 |
$4,242.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,994.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,491.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,169.28
|
| 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 |
$998.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$3,743.25
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$3,244.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$907.88
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$4,242.35
|
| Rate for Payer: Prime Health Services Medicare |
$962.35
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$998.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,994.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,495.50
|
| 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
|
IP
|
$3,978.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.60 |
| Max. Negotiated Rate |
$3,580.20 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,784.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,591.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,526.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,347.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
|
|
HC INJ INTER LMBR/SAC WO GUID
|
Facility
|
OP
|
$3,978.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$238.22 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| 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 |
$1,790.10
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Cigna of CA HMO |
$2,545.92
|
| Rate for Payer: Cigna of CA PPO |
$2,943.72
|
| 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 |
$2,784.60
|
| 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 |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$238.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,526.03
|
| 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 |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| 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 |
$3,381.30
|
| 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 |
$2,386.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,989.00
|
| 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 LMBR/SAC INC CATH W GUID
|
Facility
|
IP
|
$6,578.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
907262327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,315.60 |
| Max. Negotiated Rate |
$5,920.20 |
| Rate for Payer: Adventist Health Commercial |
$1,315.60
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,262.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,604.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,631.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,631.20
|
| Rate for Payer: Galaxy Health WC |
$5,591.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,946.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,920.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,177.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,881.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.60
|
| Rate for Payer: Multiplan Commercial |
$4,933.50
|
| Rate for Payer: Networks By Design Commercial |
$4,275.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,591.30
|
|
|
HC INJ LMBR/SAC INC CATH W GUID
|
Facility
|
OP
|
$6,578.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
907262327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$345.79 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,315.60
|
| 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 |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,262.40
|
| Rate for Payer: Cigna of CA HMO |
$4,209.92
|
| Rate for Payer: Cigna of CA PPO |
$4,867.72
|
| 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 |
$4,604.60
|
| 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 |
$5,591.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,946.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,920.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$345.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,177.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$381.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$4,933.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$4,275.70
|
| 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 |
$5,591.30
|
| 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 |
$3,946.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,289.00
|
| 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 |
$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 LMBR/SAC INC CATH WO GUID
|
Facility
|
IP
|
$5,980.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
907262326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,196.00 |
| Max. Negotiated Rate |
$5,382.00 |
| Rate for Payer: Adventist Health Commercial |
$1,196.00
|
| Rate for Payer: Cash Price |
$2,691.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,784.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,186.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,392.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,392.00
|
| Rate for Payer: Galaxy Health WC |
$5,083.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,588.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,382.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,797.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,528.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.00
|
| Rate for Payer: Multiplan Commercial |
$4,485.00
|
| Rate for Payer: Networks By Design Commercial |
$3,887.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,083.00
|
|
|
HC INJ LMBR/SAC INC CATH WO GUID
|
Facility
|
OP
|
$5,980.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
907262326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.44 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,196.00
|
| 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 |
$2,691.00
|
| Rate for Payer: Cash Price |
$2,691.00
|
| Rate for Payer: Cash Price |
$2,691.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,784.00
|
| Rate for Payer: Cigna of CA HMO |
$3,827.20
|
| Rate for Payer: Cigna of CA PPO |
$4,425.20
|
| 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 |
$4,186.00
|
| 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 |
$5,083.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,588.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,382.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$232.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,797.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$256.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$4,485.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$3,887.00
|
| 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 |
$5,083.00
|
| 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 |
$3,588.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,990.00
|
| 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 NC FOAM SCLEROSANT W US CMPSN
|
Facility
|
IP
|
$6,634.00
|
|
|
Service Code
|
CPT 36465
|
| Hospital Charge Code |
906811877
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,326.80 |
| Max. Negotiated Rate |
$5,970.60 |
| Rate for Payer: Adventist Health Commercial |
$1,326.80
|
| Rate for Payer: Cash Price |
$2,985.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,307.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,643.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,653.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,653.60
|
| Rate for Payer: Galaxy Health WC |
$5,638.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,980.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,970.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,212.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,914.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.80
|
| Rate for Payer: Multiplan Commercial |
$4,975.50
|
| Rate for Payer: Networks By Design Commercial |
$4,312.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,638.90
|
|
|
HC INJ NC FOAM SCLEROSANT W US CMPSN
|
Facility
|
OP
|
$6,634.00
|
|
|
Service Code
|
CPT 36465
|
| Hospital Charge Code |
906811877
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,326.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,326.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| 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 |
$3,703.23
|
| 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 |
$2,985.30
|
| Rate for Payer: Cash Price |
$2,985.30
|
| Rate for Payer: Cash Price |
$2,985.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,307.20
|
| Rate for Payer: Cigna of CA HMO |
$4,245.76
|
| Rate for Payer: Cigna of CA PPO |
$4,909.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,643.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$5,638.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,980.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,970.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,546.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,212.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,813.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$4,975.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$4,312.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$5,638.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,980.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,317.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC INJ NEURO SUB W WO THRPTC SUB EPDRL, LMBR, SCRL
|
Facility
|
OP
|
$3,286.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
909000282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$231.17 |
| 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 |
$231.17
|
| 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 |
$255.36
|
| 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 NEURO SUB W WO THRPTC SUB EPDRL, LMBR, SCRL
|
Facility
|
IP
|
$3,286.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
909000282
|
|
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 OF ANESTHETIC/ANTIPASMODE
|
Facility
|
IP
|
$2,808.00
|
|
|
Service Code
|
CPT 72275
|
| Hospital Charge Code |
909001356
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$561.60 |
| Max. Negotiated Rate |
$2,527.20 |
| Rate for Payer: Adventist Health Commercial |
$561.60
|
| Rate for Payer: Cash Price |
$1,263.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,246.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,965.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,123.20
|
| Rate for Payer: Galaxy Health WC |
$2,386.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,684.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,527.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,783.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,656.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Multiplan Commercial |
$2,106.00
|
| Rate for Payer: Networks By Design Commercial |
$1,825.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,386.80
|
|
|
HC INJ OF ANESTHETIC/ANTIPASMODE
|
Facility
|
OP
|
$2,808.00
|
|
|
Service Code
|
CPT 72275
|
| Hospital Charge Code |
909001356
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$443.88 |
| Max. Negotiated Rate |
$2,527.20 |
| Rate for Payer: Adventist Health Commercial |
$561.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,705.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,386.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,544.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,106.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$443.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$617.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,769.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,114.78
|
| Rate for Payer: Cash Price |
$1,263.60
|
| Rate for Payer: Cash Price |
$1,263.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,246.40
|
| Rate for Payer: Cigna of CA HMO |
$1,797.12
|
| Rate for Payer: Cigna of CA PPO |
$2,077.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,386.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,386.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,386.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,965.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,123.20
|
| Rate for Payer: Galaxy Health WC |
$2,386.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,684.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,527.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,783.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,019.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,656.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,965.60
|
| Rate for Payer: Multiplan Commercial |
$2,106.00
|
| Rate for Payer: Networks By Design Commercial |
$1,825.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,386.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,123.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,684.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,684.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,404.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,404.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,404.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,404.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,386.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,386.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,386.80
|
|
|
HC INJ PROC FOR NEPH LOOP STENT GRAM
|
Facility
|
OP
|
$2,578.00
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
909000167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.94 |
| 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 |
$252.94
|
| 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 |
$279.41
|
| 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 PROC FOR NEPH LOOP STENT GRAM
|
Facility
|
IP
|
$2,578.00
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
909000167
|
|
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 SCLEROSING SOL SINGLE VEIN
|
Facility
|
IP
|
$1,294.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
909036470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.80 |
| Max. Negotiated Rate |
$1,164.60 |
| Rate for Payer: Adventist Health Commercial |
$258.80
|
| Rate for Payer: Cash Price |
$582.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,035.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$905.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$517.60
|
| Rate for Payer: EPIC Health Plan Senior |
$517.60
|
| Rate for Payer: Galaxy Health WC |
$1,099.90
|
| Rate for Payer: Global Benefits Group Commercial |
$776.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,164.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$821.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$763.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.80
|
| Rate for Payer: Multiplan Commercial |
$970.50
|
| Rate for Payer: Networks By Design Commercial |
$841.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,099.90
|
|
|
HC INJ SCLEROSING SOL SINGLE VEIN
|
Facility
|
OP
|
$1,294.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
909036470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.91 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$258.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$522.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 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 |
$808.84
|
| 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 |
$582.30
|
| Rate for Payer: Cash Price |
$582.30
|
| Rate for Payer: Cash Price |
$582.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,035.20
|
| Rate for Payer: Cigna of CA HMO |
$828.16
|
| Rate for Payer: Cigna of CA PPO |
$957.56
|
| 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 |
$905.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,099.90
|
| Rate for Payer: Global Benefits Group Commercial |
$776.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,164.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$821.69
|
| 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 |
$258.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$970.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$841.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,099.90
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$776.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$647.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 SOLUTION HEMORR
|
Facility
|
OP
|
$6,611.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
900501731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$5,949.90 |
| Rate for Payer: Adventist Health Commercial |
$1,322.20
|
| 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 |
$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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,845.73
|
| Rate for Payer: Cash Price |
$2,974.95
|
| Rate for Payer: Cash Price |
$2,974.95
|
| Rate for Payer: Cash Price |
$2,974.95
|
| Rate for Payer: Cash Price |
$2,974.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,288.80
|
| Rate for Payer: Cigna of CA HMO |
$4,231.04
|
| Rate for Payer: Cigna of CA PPO |
$4,892.14
|
| 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 |
$4,627.70
|
| 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 |
$5,619.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,966.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,949.90
|
| 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 |
$4,197.98
|
| 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 |
$1,322.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$4,958.25
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: Networks By Design Commercial |
$4,297.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Preferred Health Network WC |
$1,883.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,619.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,267.84
|
| Rate for Payer: Prime Health Services WC |
$1,826.90
|
| Rate for Payer: Riverside University Health System MISP |
$1,315.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,966.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,305.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,305.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,305.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,305.50
|
| 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 SCLEROSING SOLUTION HEMORR
|
Facility
|
IP
|
$6,611.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
900501731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,322.20 |
| Max. Negotiated Rate |
$5,949.90 |
| Rate for Payer: Adventist Health Commercial |
$1,322.20
|
| Rate for Payer: Cash Price |
$2,974.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,288.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,627.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,644.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,644.40
|
| Rate for Payer: Galaxy Health WC |
$5,619.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,966.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,949.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,197.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,900.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,322.20
|
| Rate for Payer: Multiplan Commercial |
$4,958.25
|
| Rate for Payer: Networks By Design Commercial |
$4,297.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,619.35
|
|
|
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 |
$149.40 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Blue Shield of California Commercial |
$133.13
|
| Rate for Payer: Blue Shield of California EPN |
$83.66
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| 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: Health Management Network EPO/PPO |
$149.40
|
| 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 |
$33.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
|
|
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 |
$149.40 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.03
|
| 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 Exchange |
$57.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.55
|
| Rate for Payer: Blue Shield of California Commercial |
$105.24
|
| Rate for Payer: Blue Shield of California EPN |
$66.23
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| 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: Health Management Network EPO/PPO |
$149.40
|
| 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 |
$33.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$116.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
| Rate for Payer: Riverside University Health System MISP |
$66.40
|
| 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 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 |
$1,536.30 |
| Rate for Payer: Adventist Health Commercial |
$341.40
|
| Rate for Payer: Cash Price |
$768.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,365.60
|
| 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: Health Management Network EPO/PPO |
$1,536.30
|
| 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 |
$341.40
|
| Rate for Payer: Multiplan Commercial |
$1,280.25
|
| Rate for Payer: Networks By Design Commercial |
$1,109.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,450.95
|
|
|
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 |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$699.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$236.96
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Cash Price |
$768.15
|
| Rate for Payer: Cash Price |
$768.15
|
| Rate for Payer: Cash Price |
$768.15
|
| Rate for Payer: Cash Price |
$768.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,365.60
|
| 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: Health Management Network EPO/PPO |
$1,536.30
|
| 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 |
$341.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,280.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,109.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,450.95
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| 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 TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$674.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.31
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Cigna of CA HMO |
$1,053.44
|
| Rate for Payer: Cigna of CA PPO |
$1,218.04
|
| 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 |
$1,152.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| 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 |
$1,045.21
|
| 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 |
$329.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$987.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$987.60
|
| 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 TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,152.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.40
|
| Rate for Payer: EPIC Health Plan Senior |
$658.40
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,045.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$971.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
|
