|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Adventist Health Commercial |
$475.00
|
| Rate for Payer: Cash Price |
$1,306.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,900.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$950.00
|
| Rate for Payer: Galaxy Health WC |
$2,018.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,425.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,137.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,584.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$904.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,470.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.00
|
| Rate for Payer: Multiplan Commercial |
$1,781.25
|
| Rate for Payer: Networks By Design Commercial |
$1,543.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,018.75
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$973.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,394.84
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Cash Price |
$1,306.25
|
| Rate for Payer: Cash Price |
$1,306.25
|
| Rate for Payer: Cash Price |
$1,306.25
|
| Rate for Payer: Cash Price |
$1,306.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,900.00
|
| Rate for Payer: Cigna of CA HMO |
$1,520.00
|
| Rate for Payer: Cigna of CA PPO |
$1,757.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$2,018.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,425.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,137.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: InnovAge PACE Commercial |
$562.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,584.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,781.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,543.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$375.07
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$2,018.75
|
| Rate for Payer: Prime Health Services Medicare |
$397.57
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$412.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,425.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,425.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJ ANES BRACHIAL PLEXUS SNGLE
|
Facility
|
OP
|
$4,009.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
900100646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.24 |
| Max. Negotiated Rate |
$3,608.10 |
| Rate for Payer: Adventist Health Commercial |
$801.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Cash Price |
$2,204.95
|
| Rate for Payer: Cash Price |
$2,204.95
|
| Rate for Payer: Cash Price |
$2,204.95
|
| Rate for Payer: Cash Price |
$2,204.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,207.20
|
| Rate for Payer: Cigna of CA HMO |
$2,565.76
|
| Rate for Payer: Cigna of CA PPO |
$2,966.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$3,407.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,405.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,608.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,674.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$3,006.75
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,605.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,407.65
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,405.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,004.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,004.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,004.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,004.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ ANES BRACHIAL PLEXUS SNGLE
|
Facility
|
IP
|
$4,009.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
900100646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$801.80 |
| Max. Negotiated Rate |
$3,608.10 |
| Rate for Payer: Adventist Health Commercial |
$801.80
|
| Rate for Payer: Cash Price |
$2,204.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,603.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,603.60
|
| Rate for Payer: Galaxy Health WC |
$3,407.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,405.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,608.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,674.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,527.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.80
|
| Rate for Payer: Multiplan Commercial |
$3,006.75
|
| Rate for Payer: Networks By Design Commercial |
$2,605.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,407.65
|
|
|
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 |
$1,366.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,987.20
|
| 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 Permanente of CA Commercial/Self Funded |
$1,656.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,537.60
|
| 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 ILIOING ILIOHYPO NRV
|
Facility
|
OP
|
$2,484.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
900100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.47 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$496.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$879.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,366.20
|
| Rate for Payer: Cash Price |
$1,366.20
|
| Rate for Payer: Cash Price |
$1,366.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,987.20
|
| Rate for Payer: Cigna of CA HMO |
$1,589.76
|
| Rate for Payer: Cigna of CA PPO |
$1,838.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| 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: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,656.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,863.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,490.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
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 |
$1,807.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,628.80
|
| 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 Permanente of CA Commercial/Self Funded |
$2,191.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,034.03
|
| 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 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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$657.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,807.30
|
| Rate for Payer: Cash Price |
$1,807.30
|
| Rate for Payer: Cash Price |
$1,807.30
|
| 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 |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,793.10
|
| 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 |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$144.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,191.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| 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 |
$1,131.20
|
| 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 |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,971.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ 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 |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$657.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,807.30
|
| Rate for Payer: Cash Price |
$1,807.30
|
| Rate for Payer: Cash Price |
$1,807.30
|
| 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 |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,793.10
|
| 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 |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$272.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,191.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| 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 |
$1,131.20
|
| 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 |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,971.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ 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 |
$1,807.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,628.80
|
| 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 Permanente of CA Commercial/Self Funded |
$2,191.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,034.03
|
| 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 |
$1,417.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,062.40
|
| 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 Permanente of CA Commercial/Self Funded |
$1,719.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$982.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,595.78
|
| 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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$515.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$848.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,351.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,417.90
|
| Rate for Payer: Cash Price |
$1,417.90
|
| Rate for Payer: Cash Price |
$1,417.90
|
| 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 |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.92
|
| Rate for Payer: EPIC Health Plan Senior |
$848.09
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,390.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$817.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: InnovAge PACE Commercial |
$1,272.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,719.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$902.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,136.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,136.44
|
| 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 |
$848.09
|
| 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 |
$898.98
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Riverside University Health System MISP |
$932.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,546.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$848.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
|
HC INJ 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 |
$374.55
|
| Rate for Payer: Central Health Plan Commercial |
$544.80
|
| 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 Permanente of CA Commercial/Self Funded |
$454.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.54
|
| 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
|
361
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$136.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$329.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$399.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$374.55
|
| Rate for Payer: Cash Price |
$374.55
|
| Rate for Payer: Cash Price |
$374.55
|
| 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: 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: InnovAge PACE Commercial |
$340.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$476.70
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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
|
450
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$2,901.00
|
| 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 |
$2,582.00
|
| Rate for Payer: Cash Price |
$374.55
|
| Rate for Payer: Cash Price |
$374.55
|
| Rate for Payer: Cash Price |
$374.55
|
| Rate for Payer: Cash Price |
$374.55
|
| 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: 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: InnovAge PACE Commercial |
$340.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$476.70
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$374.55
|
| Rate for Payer: Central Health Plan Commercial |
$544.80
|
| 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 Permanente of CA Commercial/Self Funded |
$454.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.54
|
| 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
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906820298
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,740.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,481.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,184.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,649.90
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,609.60
|
| Rate for Payer: Cigna of CA HMO |
$2,887.68
|
| Rate for Payer: Cigna of CA PPO |
$3,338.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,835.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,060.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,256.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,158.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,158.40
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,804.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,707.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,707.20
|
| 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 |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,835.20
|
|
|
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 |
$676.00 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$767.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,329.00
|
| 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 |
$2,252.30
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,109.25
|
| Rate for Payer: Cash Price |
$2,109.25
|
| 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: 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: InnovAge PACE Commercial |
$1,917.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,557.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,373.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,684.50
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$2,109.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,068.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,557.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,461.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,373.86
|
| 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
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906820298
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$902.40 |
| Max. Negotiated Rate |
$4,060.80 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,609.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,060.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.40
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
|
|
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 |
$676.00 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$767.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,329.00
|
| 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 |
$2,252.30
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,109.25
|
| Rate for Payer: Cash Price |
$2,109.25
|
| 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: 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: InnovAge PACE Commercial |
$1,917.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,557.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,373.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,684.50
|
| Rate for Payer: Molina Healthcare of CA 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
|
$4,512.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906820296
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,740.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,481.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,184.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,649.90
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,609.60
|
| Rate for Payer: Cigna of CA HMO |
$2,887.68
|
| Rate for Payer: Cigna of CA PPO |
$3,338.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,835.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,060.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,256.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,158.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,158.40
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,804.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,707.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,707.20
|
| 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 |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906820296
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$902.40 |
| Max. Negotiated Rate |
$4,060.80 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,609.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,060.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.40
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
|
|
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 |
$2,109.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,068.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,557.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,461.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,373.86
|
| 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 |
$2,109.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,068.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,557.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,461.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,373.86
|
| 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
|
|
