|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
OP
|
$3,835.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906811569
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$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 UNI
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906820295
|
|
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 UNI
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906820295
|
|
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 VN ANGRPHY
|
Facility
|
IP
|
$3,835.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906811574
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$3,451.50 |
| Rate for Payer: Adventist Health Commercial |
$767.00
|
| Rate for Payer: Cash Price |
$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 VN ANGRPHY
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906820297
|
|
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 VN ANGRPHY
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906820297
|
|
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 VN ANGRPHY
|
Facility
|
OP
|
$3,835.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906811574
|
|
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 CRV/THRC INC CATH W GUID
|
Facility
|
IP
|
$4,815.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
907262325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$963.00 |
| Max. Negotiated Rate |
$4,333.50 |
| Rate for Payer: Adventist Health Commercial |
$963.00
|
| Rate for Payer: Cash Price |
$2,648.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,852.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,926.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,926.00
|
| Rate for Payer: Galaxy Health WC |
$4,092.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,889.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,333.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,211.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,834.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,980.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$963.00
|
| Rate for Payer: Multiplan Commercial |
$3,611.25
|
| Rate for Payer: Networks By Design Commercial |
$3,129.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,092.75
|
|
|
HC INJ CRV/THRC INC CATH W GUID
|
Facility
|
OP
|
$4,815.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
907262325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$336.19 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$963.00
|
| 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 |
$2,648.25
|
| Rate for Payer: Cash Price |
$2,648.25
|
| Rate for Payer: Cash Price |
$2,648.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,852.00
|
| Rate for Payer: Cigna of CA HMO |
$3,081.60
|
| Rate for Payer: Cigna of CA PPO |
$3,563.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| 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 |
$4,092.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,889.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,333.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$336.19
|
| 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 |
$3,211.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$963.00
|
| 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 |
$3,611.25
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$3,129.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,092.75
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| 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 |
$2,889.00
|
| 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 CRV/THRC INC CATH WO GUID
|
Facility
|
OP
|
$4,377.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
907262324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$219.01 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$875.40
|
| 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 |
$2,407.35
|
| Rate for Payer: Cash Price |
$2,407.35
|
| Rate for Payer: Cash Price |
$2,407.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,501.60
|
| Rate for Payer: Cigna of CA HMO |
$2,801.28
|
| Rate for Payer: Cigna of CA PPO |
$3,238.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| 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 |
$3,720.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,626.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,939.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$219.01
|
| 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 |
$2,919.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.40
|
| 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 |
$3,282.75
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,845.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,720.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| 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 |
$2,626.20
|
| 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 CRV/THRC INC CATH WO GUID
|
Facility
|
IP
|
$4,377.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
907262324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$875.40 |
| Max. Negotiated Rate |
$3,939.30 |
| Rate for Payer: Adventist Health Commercial |
$875.40
|
| Rate for Payer: Cash Price |
$2,407.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,501.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,750.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,750.80
|
| Rate for Payer: Galaxy Health WC |
$3,720.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,626.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,939.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,919.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,667.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,709.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.40
|
| Rate for Payer: Multiplan Commercial |
$3,282.75
|
| Rate for Payer: Networks By Design Commercial |
$2,845.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,720.45
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
IP
|
$1,827.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$365.40 |
| Max. Negotiated Rate |
$1,644.30 |
| Rate for Payer: Adventist Health Commercial |
$365.40
|
| Rate for Payer: Cash Price |
$1,004.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,461.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.80
|
| Rate for Payer: EPIC Health Plan Senior |
$730.80
|
| Rate for Payer: Galaxy Health WC |
$1,552.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,096.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,644.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,218.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$696.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,130.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.40
|
| Rate for Payer: Multiplan Commercial |
$1,370.25
|
| Rate for Payer: Networks By Design Commercial |
$1,187.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,552.95
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
OP
|
$1,827.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$241.42 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$365.40
|
| 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: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,004.85
|
| Rate for Payer: Cash Price |
$1,004.85
|
| Rate for Payer: Cash Price |
$1,004.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,461.60
|
| Rate for Payer: Cigna of CA HMO |
$1,169.28
|
| Rate for Payer: Cigna of CA PPO |
$1,351.98
|
| 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 |
$1,552.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,096.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,644.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$241.42
|
| 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 |
$1,218.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.40
|
| 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 |
$1,370.25
|
| Rate for Payer: Networks By Design Commercial |
$1,187.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,552.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,096.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,357.44
|
| 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 INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
IP
|
$1,827.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$365.40 |
| Max. Negotiated Rate |
$1,644.30 |
| Rate for Payer: Adventist Health Commercial |
$365.40
|
| Rate for Payer: Cash Price |
$1,004.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,461.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.80
|
| Rate for Payer: EPIC Health Plan Senior |
$730.80
|
| Rate for Payer: Galaxy Health WC |
$1,552.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,096.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,644.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,218.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$696.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,130.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.40
|
| Rate for Payer: Multiplan Commercial |
$1,370.25
|
| Rate for Payer: Networks By Design Commercial |
$1,187.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,552.95
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
OP
|
$1,827.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.42 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$365.40
|
| 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 |
$1,004.85
|
| Rate for Payer: Cash Price |
$1,004.85
|
| Rate for Payer: Cash Price |
$1,004.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,461.60
|
| Rate for Payer: Cigna of CA HMO |
$1,169.28
|
| Rate for Payer: Cigna of CA PPO |
$1,351.98
|
| 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 |
$1,552.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,096.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,644.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$241.42
|
| 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 |
$1,218.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.40
|
| 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 |
$1,370.25
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,187.55
|
| 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 |
$1,552.95
|
| 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 |
$1,096.20
|
| 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 INJECT/ASPIRATE LIVER CYST
|
Facility
|
OP
|
$8,021.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
909081848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$864.49 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,604.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,817.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,411.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,015.75
|
| 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: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,411.55
|
| Rate for Payer: Cash Price |
$4,411.55
|
| Rate for Payer: Cash Price |
$4,411.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,416.80
|
| Rate for Payer: Cigna of CA HMO |
$5,133.44
|
| Rate for Payer: Cigna of CA PPO |
$5,935.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,817.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,817.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,817.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,208.40
|
| Rate for Payer: Galaxy Health WC |
$6,817.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,812.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,218.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$864.49
|
| Rate for Payer: InnovAge PACE Commercial |
$4,010.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$954.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,965.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,604.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,614.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,614.70
|
| Rate for Payer: Multiplan Commercial |
$6,015.75
|
| Rate for Payer: Networks By Design Commercial |
$5,213.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,817.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,208.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,812.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,817.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,817.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,817.85
|
|
|
HC INJECT/ASPIRATE LIVER CYST
|
Facility
|
IP
|
$8,021.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
909081848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,604.20 |
| Max. Negotiated Rate |
$7,218.90 |
| Rate for Payer: Adventist Health Commercial |
$1,604.20
|
| Rate for Payer: Cash Price |
$4,411.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,416.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,208.40
|
| Rate for Payer: Galaxy Health WC |
$6,817.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,812.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,218.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,056.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,965.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,604.20
|
| Rate for Payer: Multiplan Commercial |
$6,015.75
|
| Rate for Payer: Networks By Design Commercial |
$5,213.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,817.85
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$313.24
|
| 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 |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$448.70
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$488.96
|
| Rate for Payer: Cigna of CA PPO |
$565.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$458.40
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.50 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$369.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$448.70
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$488.96
|
| Rate for Payer: Cigna of CA PPO |
$565.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| 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: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| 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 |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| 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 |
$402.27
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$488.96
|
| Rate for Payer: Cigna of CA PPO |
$565.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$382.00
|
| Rate for Payer: United Healthcare All Other HMO |
$382.00
|
| Rate for Payer: United Healthcare HMO Rider |
$382.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$382.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC INJECTION ADMIN SYNAGIS
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
912190471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$148.31 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.68
|
| Rate for Payer: Blue Shield of California Commercial |
$53.77
|
| Rate for Payer: Blue Shield of California EPN |
$35.11
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.43
|
| Rate for Payer: InnovAge PACE Commercial |
$135.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.43
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Prime Health Services Medicare |
$95.86
|
| Rate for Payer: Riverside University Health System MISP |
$99.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.00
|
| Rate for Payer: United Healthcare All Other HMO |
$44.00
|
| Rate for Payer: United Healthcare HMO Rider |
$44.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC INJECTION ADMIN SYNAGIS
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
912190471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
