|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$601.60 |
| Max. Negotiated Rate |
$2,707.20 |
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,146.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.60
|
| Rate for Payer: Multiplan Commercial |
$2,256.00
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
|
|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
OP
|
$3,008.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$280.82 |
| Max. Negotiated Rate |
$4,846.00 |
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,804.80
|
| 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 |
$864.04
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,406.40
|
| Rate for Payer: Cigna of CA PPO |
$2,225.92
|
| 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 |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,707.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,256.00
|
| 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 |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.60
|
| 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 |
$2,256.00
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
| 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 |
$1,804.80
|
| 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 |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
IP
|
$3,774.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$754.80 |
| Max. Negotiated Rate |
$3,396.60 |
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,019.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,509.60
|
| Rate for Payer: Galaxy Health WC |
$3,207.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,264.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,396.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,517.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,437.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.80
|
| Rate for Payer: Multiplan Commercial |
$2,830.50
|
| Rate for Payer: Networks By Design Commercial |
$2,453.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,207.90
|
|
|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
OP
|
$3,774.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$418.06 |
| Max. Negotiated Rate |
$4,846.00 |
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,264.40
|
| 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 |
$864.04
|
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,019.20
|
| Rate for Payer: Cigna of CA PPO |
$2,792.76
|
| 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 |
$3,207.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,264.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,396.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,830.50
|
| 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 |
$2,517.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.80
|
| 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 |
$2,830.50
|
| Rate for Payer: Networks By Design Commercial |
$2,453.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,207.90
|
| 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 |
$2,264.40
|
| 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 |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INJ INTER LMBR/SAC WO GUID
|
Facility
|
OP
|
$3,008.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$263.15 |
| 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 |
$1,804.80
|
| 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 |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,406.40
|
| Rate for Payer: Cigna of CA PPO |
$2,225.92
|
| 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 |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,707.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,256.00
|
| 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 |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.60
|
| 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 |
$2,256.00
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
| 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 |
$1,804.80
|
| 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 INTER LMBR/SAC WO GUID
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$601.60 |
| Max. Negotiated Rate |
$2,707.20 |
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,146.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.60
|
| Rate for Payer: Multiplan Commercial |
$2,256.00
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
|
|
HC INJ LMBR/SAC INC CATH W GUID
|
Facility
|
OP
|
$4,974.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
907262327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$381.98 |
| 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 |
$2,984.40
|
| 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 |
$2,238.30
|
| Rate for Payer: Cash Price |
$2,238.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,979.20
|
| Rate for Payer: Cigna of CA PPO |
$3,680.76
|
| 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 |
$4,227.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,984.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,476.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,730.50
|
| 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 |
$3,317.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.80
|
| 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 |
$3,730.50
|
| Rate for Payer: Networks By Design Commercial |
$3,233.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,227.90
|
| 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 |
$2,984.40
|
| 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 LMBR/SAC INC CATH W GUID
|
Facility
|
IP
|
$4,974.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
907262327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$994.80 |
| Max. Negotiated Rate |
$4,476.60 |
| Rate for Payer: Cash Price |
$2,238.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,979.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,989.60
|
| Rate for Payer: Galaxy Health WC |
$4,227.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,984.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,476.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,317.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,895.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.80
|
| Rate for Payer: Multiplan Commercial |
$3,730.50
|
| Rate for Payer: Networks By Design Commercial |
$3,233.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,227.90
|
|
|
HC INJ LMBR/SAC INC CATH WO GUID
|
Facility
|
IP
|
$4,522.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
907262326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$904.40 |
| Max. Negotiated Rate |
$4,069.80 |
| Rate for Payer: Cash Price |
$2,034.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,617.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,808.80
|
| Rate for Payer: Galaxy Health WC |
$3,843.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,713.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,069.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,016.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,722.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.40
|
| Rate for Payer: Multiplan Commercial |
$3,391.50
|
| Rate for Payer: Networks By Design Commercial |
$2,939.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,843.70
|
|
|
HC INJ LMBR/SAC INC CATH WO GUID
|
Facility
|
OP
|
$4,522.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
907262326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$256.77 |
| 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 |
$2,713.20
|
| 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 |
$2,034.90
|
| Rate for Payer: Cash Price |
$2,034.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,617.60
|
| Rate for Payer: Cigna of CA PPO |
$3,346.28
|
| 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 |
$3,843.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,713.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,069.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,391.50
|
| 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 |
$3,016.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.40
|
| 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 |
$3,391.50
|
| Rate for Payer: Networks By Design Commercial |
$2,939.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,843.70
|
| 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 |
$2,713.20
|
| 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 INJ NEURO SUB W WO THRPTC SUB EPDRL, LMBR, SCRL
|
Facility
|
IP
|
$2,484.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
909000282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$496.80 |
| Max. Negotiated Rate |
$2,235.60 |
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,987.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$993.60
|
| Rate for Payer: Galaxy Health WC |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,235.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,656.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$1,863.00
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
|
|
HC INJ NEURO SUB W WO THRPTC SUB EPDRL, LMBR, SCRL
|
Facility
|
OP
|
$2,484.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
909000282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$255.36 |
| 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 |
$1,490.40
|
| 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 |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,987.20
|
| Rate for Payer: Cigna of CA PPO |
$1,838.16
|
| 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 |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,235.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,863.00
|
| 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 |
$1,656.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| 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 |
$1,863.00
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
| 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 |
$1,490.40
|
| 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 PROC FOR NEPH LOOP STENT GRAM
|
Facility
|
IP
|
$2,637.00
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
909000167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$527.40 |
| Max. Negotiated Rate |
$2,373.30 |
| Rate for Payer: Cash Price |
$1,186.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,054.80
|
| Rate for Payer: Galaxy Health WC |
$2,241.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,373.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,758.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,004.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.40
|
| Rate for Payer: Multiplan Commercial |
$1,977.75
|
| Rate for Payer: Networks By Design Commercial |
$1,714.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,241.45
|
|
|
HC INJ PROC FOR NEPH LOOP STENT GRAM
|
Facility
|
OP
|
$2,637.00
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
909000167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.41 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$853.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$853.50
|
| 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 |
$1,582.20
|
| 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 |
$853.50
|
| Rate for Payer: Cash Price |
$1,186.65
|
| Rate for Payer: Cash Price |
$1,186.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,109.60
|
| Rate for Payer: Cigna of CA PPO |
$1,951.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Dignity Health Media |
$853.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$853.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$853.50
|
| Rate for Payer: Galaxy Health WC |
$2,241.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,373.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,977.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,408.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$853.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,280.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,758.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$853.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,143.69
|
| Rate for Payer: Multiplan Commercial |
$1,977.75
|
| Rate for Payer: Networks By Design Commercial |
$1,714.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,241.45
|
| Rate for Payer: Prime Health Services Medicare |
$904.71
|
| Rate for Payer: Riverside University Health System MISP |
$938.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,582.20
|
| 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 |
$1,280.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Vantage Medical Group Senior |
$853.50
|
|
|
HC INJ SCLEROSING SOL SINGLE VEIN
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
909036470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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 |
$586.80
|
| 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 |
$498.20
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Central Health Plan Commercial |
$782.40
|
| Rate for Payer: Cigna of CA PPO |
$723.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$831.30
|
| Rate for Payer: Global Benefits Group Commercial |
$586.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$880.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$733.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$733.50
|
| Rate for Payer: Networks By Design Commercial |
$635.70
|
| Rate for Payer: Prime Health Services Commercial |
$831.30
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$586.80
|
| 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 |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC INJ SCLEROSING SOL SINGLE VEIN
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
909036470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$880.20 |
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Central Health Plan Commercial |
$782.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.20
|
| Rate for Payer: Galaxy Health WC |
$831.30
|
| Rate for Payer: Global Benefits Group Commercial |
$586.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$880.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.60
|
| Rate for Payer: Multiplan Commercial |
$733.50
|
| Rate for Payer: Networks By Design Commercial |
$635.70
|
| Rate for Payer: Prime Health Services Commercial |
$831.30
|
|
|
HC INJ SCLEROSING SOLUTION HEMORR
|
Facility
|
IP
|
$4,999.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
900501731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$999.80 |
| Max. Negotiated Rate |
$4,499.10 |
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,999.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,999.60
|
| Rate for Payer: Galaxy Health WC |
$4,249.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,999.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,499.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,334.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,904.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$999.80
|
| Rate for Payer: Multiplan Commercial |
$3,749.25
|
| Rate for Payer: Networks By Design Commercial |
$3,249.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,249.15
|
|
|
HC INJ SCLEROSING SOLUTION HEMORR
|
Facility
|
OP
|
$4,999.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
900501731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$4,499.10 |
| 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 |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| 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 |
$2,999.40
|
| Rate for Payer: Caremore Medicare Advantage |
$1,141.93
|
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,999.20
|
| Rate for Payer: Cigna of CA PPO |
$3,699.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Media |
$1,141.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Galaxy Health WC |
$4,249.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,999.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,499.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,749.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,872.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,712.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,334.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$999.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Multiplan Commercial |
$3,749.25
|
| Rate for Payer: Networks By Design Commercial |
$3,249.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,249.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,210.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,256.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,999.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,499.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,499.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,499.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
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 |
$19.04 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$117.19
|
| 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 |
$91.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.78
|
| Rate for Payer: Blue Distinction Transplant |
$99.60
|
| Rate for Payer: Blue Shield of California Commercial |
$104.41
|
| Rate for Payer: Blue Shield of California EPN |
$81.17
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: Cigna of CA HMO |
$106.24
|
| Rate for Payer: Cigna of CA PPO |
$122.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Media |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$124.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| 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
|
| 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 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: Blue Shield of California Commercial |
$124.50
|
| Rate for Payer: Blue Shield of California EPN |
$88.64
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
$1,562.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
902890272
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| 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 |
$937.20
|
| Rate for Payer: Blue Shield of California Commercial |
$982.50
|
| Rate for Payer: Blue Shield of California EPN |
$763.82
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,249.60
|
| Rate for Payer: Cigna of CA HMO |
$999.68
|
| Rate for Payer: Cigna of CA PPO |
$1,155.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,405.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,171.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$610.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.50
|
| Rate for Payer: Networks By Design Commercial |
$1,015.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$937.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$781.00
|
| Rate for Payer: United Healthcare All Other HMO |
$781.00
|
| Rate for Payer: United Healthcare HMO Rider |
$781.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$781.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJ TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
902890272
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$312.40 |
| Max. Negotiated Rate |
$1,405.80 |
| Rate for Payer: Cash Price |
$702.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,249.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,405.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.40
|
| Rate for Payer: Multiplan Commercial |
$1,171.50
|
| Rate for Payer: Networks By Design Commercial |
$1,015.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$1,506.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$301.20 |
| Max. Negotiated Rate |
$1,355.40 |
| Rate for Payer: Cash Price |
$677.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,204.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.40
|
| Rate for Payer: Galaxy Health WC |
$1,280.10
|
| Rate for Payer: Global Benefits Group Commercial |
$903.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,355.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,004.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.20
|
| Rate for Payer: Multiplan Commercial |
$1,129.50
|
| Rate for Payer: Networks By Design Commercial |
$978.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,280.10
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$1,506.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| 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 |
$903.60
|
| Rate for Payer: Blue Shield of California Commercial |
$947.27
|
| Rate for Payer: Blue Shield of California EPN |
$736.43
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$677.70
|
| Rate for Payer: Cash Price |
$677.70
|
| Rate for Payer: Cash Price |
$677.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,204.80
|
| Rate for Payer: Cigna of CA HMO |
$963.84
|
| Rate for Payer: Cigna of CA PPO |
$1,114.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,280.10
|
| Rate for Payer: Global Benefits Group Commercial |
$903.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,355.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,129.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$610.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,004.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,129.50
|
| Rate for Payer: Networks By Design Commercial |
$978.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,280.10
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$903.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$903.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$753.00
|
| Rate for Payer: United Healthcare HMO Rider |
$753.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$1,506.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.20 |
| Max. Negotiated Rate |
$1,355.40 |
| Rate for Payer: Cash Price |
$677.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,204.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.40
|
| Rate for Payer: Galaxy Health WC |
$1,280.10
|
| Rate for Payer: Global Benefits Group Commercial |
$903.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,355.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,004.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.20
|
| Rate for Payer: Multiplan Commercial |
$1,129.50
|
| Rate for Payer: Networks By Design Commercial |
$978.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,280.10
|
|
