|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906811574
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$402.13 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$402.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,612.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,612.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,299.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,806.30
|
| Rate for Payer: Blue Distinction Transplant |
$2,850.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,800.00
|
| Rate for Payer: Cigna of CA HMO |
$3,040.00
|
| Rate for Payer: Cigna of CA PPO |
$3,515.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Dignity Health Media |
$4,037.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,900.00
|
| Rate for Payer: Galaxy Health WC |
$4,037.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,275.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,562.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,662.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.00
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
| Rate for Payer: Networks By Design Commercial |
$3,087.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,037.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,900.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,850.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,850.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,037.50
|
|
|
HC INJ CRV/THRC INC CATH W GUID
|
Facility
|
OP
|
$3,641.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
907262325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$371.37 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,184.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Cash Price |
$1,638.45
|
| Rate for Payer: Cash Price |
$1,638.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,912.80
|
| Rate for Payer: Cigna of CA PPO |
$2,694.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$3,094.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,184.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,276.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,730.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,428.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$2,730.75
|
| Rate for Payer: Networks By Design Commercial |
$2,366.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,094.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,184.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ CRV/THRC INC CATH W GUID
|
Facility
|
IP
|
$3,641.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
907262325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$728.20 |
| Max. Negotiated Rate |
$3,276.90 |
| Rate for Payer: Cash Price |
$1,638.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,912.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.40
|
| Rate for Payer: Galaxy Health WC |
$3,094.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,184.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,276.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,428.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,387.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.20
|
| Rate for Payer: Multiplan Commercial |
$2,730.75
|
| Rate for Payer: Networks By Design Commercial |
$2,366.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,094.85
|
|
|
HC INJ CRV/THRC INC CATH WO GUID
|
Facility
|
OP
|
$3,310.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
907262324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.93 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,986.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,648.00
|
| Rate for Payer: Cigna of CA PPO |
$2,449.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,813.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,986.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,979.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,482.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,207.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$662.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$2,482.50
|
| Rate for Payer: Networks By Design Commercial |
$2,151.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,813.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,986.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ CRV/THRC INC CATH WO GUID
|
Facility
|
IP
|
$3,310.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
907262324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$662.00 |
| Max. Negotiated Rate |
$2,979.00 |
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,648.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,324.00
|
| Rate for Payer: Galaxy Health WC |
$2,813.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,986.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,979.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,207.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,261.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$662.00
|
| Rate for Payer: Multiplan Commercial |
$2,482.50
|
| Rate for Payer: Networks By Design Commercial |
$2,151.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,813.50
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
IP
|
$2,501.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.20 |
| Max. Negotiated Rate |
$2,250.90 |
| Rate for Payer: Cash Price |
$1,125.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,000.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,125.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,500.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,250.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.20
|
| Rate for Payer: Multiplan Commercial |
$1,875.75
|
| Rate for Payer: Networks By Design Commercial |
$1,625.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.85
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
OP
|
$1,382.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.68 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$829.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Cash Price |
$621.90
|
| Rate for Payer: Cash Price |
$621.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,105.60
|
| Rate for Payer: Cigna of CA PPO |
$1,022.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$1,174.70
|
| Rate for Payer: Global Benefits Group Commercial |
$829.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,243.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,036.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$1,036.50
|
| Rate for Payer: Networks By Design Commercial |
$898.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,174.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$829.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
OP
|
$1,382.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$266.68 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$829.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Cash Price |
$621.90
|
| Rate for Payer: Cash Price |
$621.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,105.60
|
| Rate for Payer: Cigna of CA PPO |
$1,022.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$1,174.70
|
| Rate for Payer: Global Benefits Group Commercial |
$829.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,243.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,036.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$1,036.50
|
| Rate for Payer: Networks By Design Commercial |
$898.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,174.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$829.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,366.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
IP
|
$2,501.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$500.20 |
| Max. Negotiated Rate |
$2,250.90 |
| Rate for Payer: Cash Price |
$1,125.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,000.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,125.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,500.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,250.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.20
|
| Rate for Payer: Multiplan Commercial |
$1,875.75
|
| Rate for Payer: Networks By Design Commercial |
$1,625.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.85
|
|
|
HC INJECT/ASPIRATE LIVER CYST
|
Facility
|
OP
|
$6,065.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
909081848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$954.96 |
| Max. Negotiated Rate |
$8,017.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,800.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,155.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,335.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,335.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,639.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$2,729.25
|
| Rate for Payer: Cash Price |
$2,729.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,852.00
|
| Rate for Payer: Cigna of CA PPO |
$4,488.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,155.25
|
| Rate for Payer: Dignity Health Media |
$5,155.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,155.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,426.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,426.00
|
| Rate for Payer: Galaxy Health WC |
$5,155.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,458.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,548.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,122.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,045.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$954.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,213.00
|
| Rate for Payer: Multiplan Commercial |
$4,548.75
|
| Rate for Payer: Networks By Design Commercial |
$3,942.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,155.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,426.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,639.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,155.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,155.25
|
|
|
HC INJECT/ASPIRATE LIVER CYST
|
Facility
|
IP
|
$6,065.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
909081848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,213.00 |
| Max. Negotiated Rate |
$5,458.50 |
| Rate for Payer: Cash Price |
$2,729.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,852.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,426.00
|
| Rate for Payer: Galaxy Health WC |
$5,155.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,458.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,045.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,310.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,213.00
|
| Rate for Payer: Multiplan Commercial |
$4,548.75
|
| Rate for Payer: Networks By Design Commercial |
$3,942.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,155.25
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$115.40 |
| Max. Negotiated Rate |
$519.30 |
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Central Health Plan Commercial |
$461.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.80
|
| Rate for Payer: Galaxy Health WC |
$490.45
|
| Rate for Payer: Global Benefits Group Commercial |
$346.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.40
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
| Rate for Payer: Networks By Design Commercial |
$375.05
|
| Rate for Payer: Prime Health Services Commercial |
$490.45
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$346.20
|
| Rate for Payer: Blue Shield of California Commercial |
$362.93
|
| Rate for Payer: Blue Shield of California EPN |
$282.15
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Central Health Plan Commercial |
$461.60
|
| Rate for Payer: Cigna of CA HMO |
$369.28
|
| Rate for Payer: Cigna of CA PPO |
$426.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$490.45
|
| Rate for Payer: Global Benefits Group Commercial |
$346.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$432.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
| Rate for Payer: Networks By Design Commercial |
$375.05
|
| Rate for Payer: Prime Health Services Commercial |
$490.45
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$346.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.50
|
| Rate for Payer: United Healthcare All Other HMO |
$288.50
|
| Rate for Payer: United Healthcare HMO Rider |
$288.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.40 |
| Max. Negotiated Rate |
$519.30 |
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Central Health Plan Commercial |
$461.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.80
|
| Rate for Payer: Galaxy Health WC |
$490.45
|
| Rate for Payer: Global Benefits Group Commercial |
$346.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.40
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
| Rate for Payer: Networks By Design Commercial |
$375.05
|
| Rate for Payer: Prime Health Services Commercial |
$490.45
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$346.20
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Central Health Plan Commercial |
$461.60
|
| Rate for Payer: Cigna of CA PPO |
$426.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$490.45
|
| Rate for Payer: Global Benefits Group Commercial |
$346.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$432.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
| Rate for Payer: Networks By Design Commercial |
$375.05
|
| Rate for Payer: Prime Health Services Commercial |
$490.45
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.40 |
| Max. Negotiated Rate |
$519.30 |
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Central Health Plan Commercial |
$461.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.80
|
| Rate for Payer: Galaxy Health WC |
$490.45
|
| Rate for Payer: Global Benefits Group Commercial |
$346.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.40
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
| Rate for Payer: Networks By Design Commercial |
$375.05
|
| Rate for Payer: Prime Health Services Commercial |
$490.45
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$577.00
|
|
|
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 Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$346.20
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Central Health Plan Commercial |
$461.60
|
| Rate for Payer: Cigna of CA PPO |
$426.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$490.45
|
| Rate for Payer: Global Benefits Group Commercial |
$346.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$432.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
| Rate for Payer: Networks By Design Commercial |
$375.05
|
| Rate for Payer: Prime Health Services Commercial |
$490.45
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.50
|
| Rate for Payer: United Healthcare All Other HMO |
$288.50
|
| Rate for Payer: United Healthcare HMO Rider |
$288.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC INJECTION ADMIN SYNAGIS
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
912190471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
|
|
HC INJECTION ADMIN SYNAGIS
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
912190471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$145.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.94
|
| Rate for Payer: Blue Distinction Transplant |
$55.80
|
| Rate for Payer: Blue Shield of California Commercial |
$58.50
|
| Rate for Payer: Blue Shield of California EPN |
$45.48
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: Cigna of CA HMO |
$59.52
|
| Rate for Payer: Cigna of CA PPO |
$68.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$69.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.02
|
| Rate for Payer: InnovAge PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Riverside University Health System MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.50
|
| Rate for Payer: United Healthcare All Other HMO |
$46.50
|
| Rate for Payer: United Healthcare HMO Rider |
$46.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC INJECTION EYE DRUG
|
Facility
|
OP
|
$1,672.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
900501532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$334.40 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,003.20
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,337.60
|
| Rate for Payer: Cigna of CA PPO |
$1,237.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$1,421.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,504.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,254.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: InnovAge PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$1,254.00
|
| Rate for Payer: Networks By Design Commercial |
$1,086.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,421.20
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Riverside University Health System MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,003.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$836.00
|
| Rate for Payer: United Healthcare HMO Rider |
$836.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$836.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC INJECTION EYE DRUG
|
Facility
|
IP
|
$1,672.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
900501532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$334.40 |
| Max. Negotiated Rate |
$1,504.80 |
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,337.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$668.80
|
| Rate for Payer: Galaxy Health WC |
$1,421.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,504.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$637.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.40
|
| Rate for Payer: Multiplan Commercial |
$1,254.00
|
| Rate for Payer: Networks By Design Commercial |
$1,086.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,421.20
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$2,395.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$479.00 |
| Max. Negotiated Rate |
$2,155.50 |
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,916.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$958.00
|
| Rate for Payer: Galaxy Health WC |
$2,035.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,437.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,155.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,597.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$912.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.00
|
| Rate for Payer: Multiplan Commercial |
$1,796.25
|
| Rate for Payer: Networks By Design Commercial |
$1,556.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,035.75
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$2,395.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$864.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,437.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,506.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,171.16
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,916.00
|
| Rate for Payer: Cigna of CA HMO |
$1,532.80
|
| Rate for Payer: Cigna of CA PPO |
$1,772.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$2,035.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,437.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,155.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,796.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,425.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: InnovAge PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,597.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,796.25
|
| Rate for Payer: Networks By Design Commercial |
$1,556.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,035.75
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health System MISP |
$950.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,437.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,437.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,197.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,197.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,197.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,197.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$2,395.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,437.00
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,916.00
|
| Rate for Payer: Cigna of CA PPO |
$1,772.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$2,035.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,437.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,155.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,796.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: InnovAge PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,597.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,796.25
|
| Rate for Payer: Networks By Design Commercial |
$1,556.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,035.75
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health System MISP |
$950.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,437.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,197.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,197.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,197.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,197.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$2,395.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$479.00 |
| Max. Negotiated Rate |
$2,155.50 |
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,916.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$958.00
|
| Rate for Payer: Galaxy Health WC |
$2,035.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,437.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,155.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,597.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$912.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.00
|
| Rate for Payer: Multiplan Commercial |
$1,796.25
|
| Rate for Payer: Networks By Design Commercial |
$1,556.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,035.75
|
|
