|
HC INJ SCLEROSING SOL SINGLE VEIN
|
Facility
|
OP
|
$1,294.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
909036470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.91 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$258.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$507.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| 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 |
$808.84
|
| 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 |
$711.70
|
| Rate for Payer: Cash Price |
$711.70
|
| Rate for Payer: Cash Price |
$711.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,035.20
|
| Rate for Payer: Cigna of CA HMO |
$828.16
|
| Rate for Payer: Cigna of CA PPO |
$957.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,099.90
|
| Rate for Payer: Global Benefits Group Commercial |
$776.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,164.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$863.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$970.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$841.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,099.90
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$776.40
|
| 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 |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC INJ SCLEROSING SOLUTION HEMORR
|
Facility
|
IP
|
$6,611.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
900501731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,322.20 |
| Max. Negotiated Rate |
$5,949.90 |
| Rate for Payer: Adventist Health Commercial |
$1,322.20
|
| Rate for Payer: Cash Price |
$3,636.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,288.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,644.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,644.40
|
| Rate for Payer: Galaxy Health WC |
$5,619.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,966.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,949.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,409.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,518.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,092.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,322.20
|
| Rate for Payer: Multiplan Commercial |
$4,958.25
|
| Rate for Payer: Networks By Design Commercial |
$4,297.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,619.35
|
|
|
HC INJ SCLEROSING SOLUTION HEMORR
|
Facility
|
OP
|
$6,611.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
900501731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$5,949.90 |
| Rate for Payer: Adventist Health Commercial |
$1,322.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| 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 |
$1,845.73
|
| Rate for Payer: Cash Price |
$3,636.05
|
| Rate for Payer: Cash Price |
$3,636.05
|
| Rate for Payer: Cash Price |
$3,636.05
|
| Rate for Payer: Cash Price |
$3,636.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,288.80
|
| Rate for Payer: Cigna of CA HMO |
$4,231.04
|
| Rate for Payer: Cigna of CA PPO |
$4,892.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$5,619.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,966.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,949.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: InnovAge PACE Commercial |
$1,737.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,409.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,322.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,552.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$4,958.25
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: Networks By Design Commercial |
$4,297.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Preferred Health Network WC |
$1,883.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,619.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,227.93
|
| Rate for Payer: Prime Health Services WC |
$1,826.90
|
| Rate for Payer: Riverside University Health System MISP |
$1,274.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,966.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,305.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,305.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,305.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,305.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC INJ SULFUR HEXA LUMASON PER ML
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT Q9950
|
| Hospital Charge Code |
906609950
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.18
|
| Rate for Payer: Blue Shield of California Commercial |
$101.43
|
| Rate for Payer: Blue Shield of California EPN |
$66.23
|
| Rate for Payer: Cash Price |
$91.30
|
| Rate for Payer: Cash Price |
$91.30
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: Cigna of CA HMO |
$106.24
|
| Rate for Payer: Cigna of CA PPO |
$122.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.72
|
| Rate for Payer: InnovAge PACE Commercial |
$83.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$116.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
| Rate for Payer: Riverside University Health System MISP |
$66.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.00
|
| Rate for Payer: United Healthcare All Other HMO |
$83.00
|
| Rate for Payer: United Healthcare HMO Rider |
$83.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC INJ SULFUR HEXA LUMASON PER ML
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT Q9950
|
| Hospital Charge Code |
906609950
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Blue Shield of California Commercial |
$128.32
|
| Rate for Payer: Blue Shield of California EPN |
$83.66
|
| Rate for Payer: Cash Price |
$91.30
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
|
|
HC INJ TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$1,707.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
902890272
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$699.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$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 |
$1,002.52
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Cash Price |
$938.85
|
| Rate for Payer: Cash Price |
$938.85
|
| Rate for Payer: Cash Price |
$938.85
|
| Rate for Payer: Cash Price |
$938.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,365.60
|
| Rate for Payer: Cigna of CA HMO |
$1,092.48
|
| Rate for Payer: Cigna of CA PPO |
$1,263.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,450.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,024.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,536.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 |
$1,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.40
|
| 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 |
$1,280.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,109.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$375.07
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,450.95
|
| Rate for Payer: Prime Health Services Medicare |
$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 |
$1,024.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,024.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$1,707.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
902890272
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$341.40 |
| Max. Negotiated Rate |
$1,536.30 |
| Rate for Payer: Adventist Health Commercial |
$341.40
|
| Rate for Payer: Cash Price |
$938.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,365.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.80
|
| Rate for Payer: EPIC Health Plan Senior |
$682.80
|
| Rate for Payer: Galaxy Health WC |
$1,450.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,024.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,536.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$650.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,056.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.40
|
| Rate for Payer: Multiplan Commercial |
$1,280.25
|
| Rate for Payer: Networks By Design Commercial |
$1,109.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,450.95
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.40
|
| Rate for Payer: EPIC Health Plan Senior |
$658.40
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,097.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,018.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$375.07
|
| 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 |
$796.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$966.70
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| 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 |
$905.30
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Cigna of CA HMO |
$1,053.44
|
| Rate for Payer: Cigna of CA PPO |
$1,218.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.76
|
| 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 |
$1,097.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| 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 |
$1,234.50
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$375.07
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
| Rate for Payer: Prime Health Services Medicare |
$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 |
$987.60
|
| 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: 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 TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| 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 |
$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 |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Cigna of CA HMO |
$1,053.44
|
| Rate for Payer: Cigna of CA PPO |
$1,218.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 |
$1,097.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| 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 |
$1,234.50
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$375.07
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
| Rate for Payer: Prime Health Services Medicare |
$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 |
$987.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$823.00
|
| Rate for Payer: United Healthcare All Other HMO |
$823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$823.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$823.00
|
| 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 TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.40
|
| Rate for Payer: EPIC Health Plan Senior |
$658.40
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,097.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,018.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$674.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$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 |
$966.70
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Cigna of CA HMO |
$1,053.44
|
| Rate for Payer: Cigna of CA PPO |
$1,218.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 |
$1,097.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| 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 |
$1,234.50
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$375.07
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
| Rate for Payer: Prime Health Services Medicare |
$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 |
$987.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$987.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.40
|
| Rate for Payer: EPIC Health Plan Senior |
$658.40
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,097.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,018.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$442.60 |
| Max. Negotiated Rate |
$1,991.70 |
| Rate for Payer: Adventist Health Commercial |
$442.60
|
| Rate for Payer: Cash Price |
$1,217.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,770.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.20
|
| Rate for Payer: EPIC Health Plan Senior |
$885.20
|
| Rate for Payer: Galaxy Health WC |
$1,881.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,327.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,991.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,476.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$843.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.60
|
| Rate for Payer: Multiplan Commercial |
$1,659.75
|
| Rate for Payer: Networks By Design Commercial |
$1,438.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,881.05
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.70 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$442.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$375.07
|
| 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 |
$1,071.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,299.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,343.29
|
| Rate for Payer: Blue Shield of California EPN |
$878.56
|
| Rate for Payer: Cash Price |
$1,217.15
|
| Rate for Payer: Cash Price |
$1,217.15
|
| Rate for Payer: Cash Price |
$1,217.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,770.40
|
| Rate for Payer: Cigna of CA HMO |
$1,416.32
|
| Rate for Payer: Cigna of CA PPO |
$1,637.62
|
| 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 |
$1,881.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,327.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,991.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.70
|
| 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 |
$1,476.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.60
|
| 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 |
$1,659.75
|
| Rate for Payer: Networks By Design Commercial |
$1,438.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$375.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,881.05
|
| Rate for Payer: Prime Health Services Medicare |
$397.57
|
| Rate for Payer: Riverside University Health System MISP |
$412.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,327.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,327.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,106.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,106.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,106.50
|
| 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 TRIGGER PTS 3+
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$907.33
|
| 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 |
$1,299.69
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Cash Price |
$1,217.15
|
| Rate for Payer: Cash Price |
$1,217.15
|
| Rate for Payer: Cash Price |
$1,217.15
|
| Rate for Payer: Cash Price |
$1,217.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,770.40
|
| Rate for Payer: Cigna of CA HMO |
$1,416.32
|
| Rate for Payer: Cigna of CA PPO |
$1,637.62
|
| 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 |
$1,881.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,327.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,991.70
|
| 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 |
$1,476.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.60
|
| 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 |
$1,659.75
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,438.45
|
| 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 |
$1,881.05
|
| 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 |
$1,327.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,327.80
|
| 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 TRIGGER PTS 3+
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$442.60 |
| Max. Negotiated Rate |
$1,991.70 |
| Rate for Payer: Adventist Health Commercial |
$442.60
|
| Rate for Payer: Cash Price |
$1,217.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,770.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.20
|
| Rate for Payer: EPIC Health Plan Senior |
$885.20
|
| Rate for Payer: Galaxy Health WC |
$1,881.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,327.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,991.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,476.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$843.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.60
|
| Rate for Payer: Multiplan Commercial |
$1,659.75
|
| Rate for Payer: Networks By Design Commercial |
$1,438.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,881.05
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906820129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$292.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.32
|
| 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 |
$332.75
|
| Rate for Payer: Cash Price |
$332.75
|
| Rate for Payer: Cash Price |
$332.75
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: Cigna of CA HMO |
$387.20
|
| Rate for Payer: Cigna of CA PPO |
$447.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$494.36
|
| Rate for Payer: InnovAge PACE Commercial |
$302.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Riverside University Health System MISP |
$242.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| 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 |
$514.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906820129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Cash Price |
$332.75
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.00
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$248.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.87
|
| Rate for Payer: Blue Shield of California Commercial |
$312.00
|
| Rate for Payer: Blue Shield of California EPN |
$204.06
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$328.96
|
| Rate for Payer: Cigna of CA PPO |
$380.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$436.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$436.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$436.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$494.36
|
| Rate for Payer: InnovAge PACE Commercial |
$257.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$359.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Riverside University Health System MISP |
$205.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.00
|
| Rate for Payer: United Healthcare All Other HMO |
$257.00
|
| Rate for Payer: United Healthcare HMO Rider |
$257.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$436.90
|
| Rate for Payer: Vantage Medical Group Senior |
$436.90
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$248.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.87
|
| 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 |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$328.96
|
| Rate for Payer: Cigna of CA PPO |
$380.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$436.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$436.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$436.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$494.36
|
| Rate for Payer: InnovAge PACE Commercial |
$257.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$359.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Riverside University Health System MISP |
$205.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$436.90
|
| Rate for Payer: Vantage Medical Group Senior |
$436.90
|
|
|
HC INNER CANNULA
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
900800704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC INNER CANNULA
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
900800704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.10
|
| Rate for Payer: Blue Shield of California Commercial |
$14.66
|
| Rate for Payer: Blue Shield of California EPN |
$9.58
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: InnovAge PACE Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
