|
HC NEPHROSTOMY CATH KIT
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.75
|
| Rate for Payer: Blue Shield of California Commercial |
$241.18
|
| Rate for Payer: Blue Shield of California EPN |
$157.25
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Central Health Plan Commercial |
$249.60
|
| Rate for Payer: Cigna of CA HMO |
$218.40
|
| Rate for Payer: Cigna of CA PPO |
$218.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$265.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$265.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.80
|
| Rate for Payer: InnovAge PACE Commercial |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Networks By Design Commercial |
$156.00
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
| Rate for Payer: Riverside University Health System MISP |
$124.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.09
|
| Rate for Payer: United Healthcare All Other HMO |
$113.97
|
| Rate for Payer: United Healthcare HMO Rider |
$111.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.20
|
| Rate for Payer: Vantage Medical Group Senior |
$265.20
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
|
OP
|
$4,486.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.03 |
| Max. Negotiated Rate |
$4,268.66 |
| Rate for Payer: Adventist Health Commercial |
$897.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,602.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,724.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$655.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,723.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,780.94
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,588.80
|
| Rate for Payer: Cigna of CA HMO |
$2,871.04
|
| Rate for Payer: Cigna of CA PPO |
$3,319.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$3,813.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,691.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,037.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$142.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,992.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$3,364.50
|
| Rate for Payer: Networks By Design Commercial |
$2,915.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,759.01
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,691.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,691.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,132.32
|
| Rate for Payer: United Healthcare All Other HMO |
$3,132.32
|
| Rate for Payer: United Healthcare HMO Rider |
$3,132.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,132.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
|
IP
|
$4,486.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$897.20 |
| Max. Negotiated Rate |
$4,037.40 |
| Rate for Payer: Adventist Health Commercial |
$897.20
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,588.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,794.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,794.40
|
| Rate for Payer: Galaxy Health WC |
$3,813.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,691.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,037.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,992.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,709.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,776.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.20
|
| Rate for Payer: Multiplan Commercial |
$3,364.50
|
| Rate for Payer: Networks By Design Commercial |
$2,915.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.10
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
OP
|
$7,238.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,514.20 |
| Rate for Payer: Adventist Health Commercial |
$1,447.60
|
| 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 |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,790.40
|
| Rate for Payer: Cigna of CA HMO |
$4,632.32
|
| Rate for Payer: Cigna of CA PPO |
$5,356.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$6,152.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,342.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,514.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,827.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,447.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$5,428.50
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$4,704.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$6,152.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,342.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,619.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,619.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,619.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,619.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
IP
|
$7,238.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,447.60 |
| Max. Negotiated Rate |
$6,514.20 |
| Rate for Payer: Adventist Health Commercial |
$1,447.60
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,790.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,895.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,895.20
|
| Rate for Payer: Galaxy Health WC |
$6,152.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,342.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,514.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,827.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,757.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,480.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,447.60
|
| Rate for Payer: Multiplan Commercial |
$5,428.50
|
| Rate for Payer: Networks By Design Commercial |
$4,704.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,152.30
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
OP
|
$7,238.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$747.29 |
| Max. Negotiated Rate |
$6,514.20 |
| Rate for Payer: Adventist Health Commercial |
$1,447.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,602.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,393.47
|
| Rate for Payer: Blue Shield of California EPN |
$2,873.49
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,790.40
|
| Rate for Payer: Cigna of CA HMO |
$4,632.32
|
| Rate for Payer: Cigna of CA PPO |
$5,356.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$6,152.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,342.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,514.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$747.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,827.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,447.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$5,428.50
|
| Rate for Payer: Networks By Design Commercial |
$4,704.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Prime Health Services Commercial |
$6,152.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,759.01
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,342.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,342.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,619.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,619.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,619.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,619.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
IP
|
$7,238.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,447.60 |
| Max. Negotiated Rate |
$6,514.20 |
| Rate for Payer: Adventist Health Commercial |
$1,447.60
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,790.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,895.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,895.20
|
| Rate for Payer: Galaxy Health WC |
$6,152.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,342.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,514.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,827.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,757.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,480.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,447.60
|
| Rate for Payer: Multiplan Commercial |
$5,428.50
|
| Rate for Payer: Networks By Design Commercial |
$4,704.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,152.30
|
|
|
HC NERVE BLOCK INJ-CERVICAL PLEXU
|
Facility
|
OP
|
$1,701.00
|
|
|
Service Code
|
CPT 64413
|
| Hospital Charge Code |
900501738
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$340.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,445.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,275.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Cash Price |
$765.45
|
| Rate for Payer: Cash Price |
$765.45
|
| Rate for Payer: Cash Price |
$765.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,360.80
|
| Rate for Payer: Cigna of CA HMO |
$1,088.64
|
| Rate for Payer: Cigna of CA PPO |
$1,258.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,445.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,445.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,445.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$680.40
|
| Rate for Payer: EPIC Health Plan Senior |
$680.40
|
| Rate for Payer: Galaxy Health WC |
$1,445.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,020.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,530.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$850.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,134.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,052.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,190.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,190.70
|
| Rate for Payer: Multiplan Commercial |
$1,275.75
|
| Rate for Payer: Networks By Design Commercial |
$1,105.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,445.85
|
| Rate for Payer: Riverside University Health System MISP |
$680.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,020.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$850.50
|
| Rate for Payer: United Healthcare All Other HMO |
$850.50
|
| Rate for Payer: United Healthcare HMO Rider |
$850.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$850.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,445.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,445.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,445.85
|
|
|
HC NERVE BLOCK INJ-CERVICAL PLEXU
|
Facility
|
IP
|
$1,701.00
|
|
|
Service Code
|
CPT 64413
|
| Hospital Charge Code |
900501738
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$1,530.90 |
| Rate for Payer: Adventist Health Commercial |
$340.20
|
| Rate for Payer: Cash Price |
$765.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,360.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$680.40
|
| Rate for Payer: EPIC Health Plan Senior |
$680.40
|
| Rate for Payer: Galaxy Health WC |
$1,445.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,020.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,530.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,134.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,052.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.20
|
| Rate for Payer: Multiplan Commercial |
$1,275.75
|
| Rate for Payer: Networks By Design Commercial |
$1,105.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,445.85
|
|
|
HC NERVE TEASING
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 88362
|
| Hospital Charge Code |
903800042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$68.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,037.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$198.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.32
|
| Rate for Payer: Blue Shield of California Commercial |
$207.59
|
| Rate for Payer: Blue Shield of California EPN |
$135.77
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Central Health Plan Commercial |
$273.60
|
| Rate for Payer: Cigna of CA HMO |
$218.88
|
| Rate for Payer: Cigna of CA PPO |
$253.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$290.70
|
| Rate for Payer: Global Benefits Group Commercial |
$205.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$310.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: InnovAge PACE Commercial |
$1,556.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,390.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$256.50
|
| Rate for Payer: Networks By Design Commercial |
$222.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Prime Health Services Commercial |
$290.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,100.23
|
| Rate for Payer: Riverside University Health System MISP |
$1,141.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$205.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC NERVE TEASING
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
CPT 88362
|
| Hospital Charge Code |
903800042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC NERVOUS SYSTEM PROC
|
Facility
|
OP
|
$10,251.00
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
907201138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$375.07 |
| Max. Negotiated Rate |
$9,225.90 |
| Rate for Payer: Adventist Health Commercial |
$2,050.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$375.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,612.95
|
| Rate for Payer: Cash Price |
$4,612.95
|
| Rate for Payer: Cash Price |
$4,612.95
|
| Rate for Payer: Central Health Plan Commercial |
$8,200.80
|
| Rate for Payer: Cigna of CA HMO |
$6,560.64
|
| Rate for Payer: Cigna of CA PPO |
$7,585.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$8,713.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,225.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: InnovAge PACE Commercial |
$562.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,837.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,050.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$7,688.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$6,663.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$375.07
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$8,713.35
|
| Rate for Payer: Prime Health Services Medicare |
$397.57
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$412.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,150.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC NERVOUS SYSTEM PROC
|
Facility
|
IP
|
$10,251.00
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
907201138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,050.20 |
| Max. Negotiated Rate |
$9,225.90 |
| Rate for Payer: Adventist Health Commercial |
$2,050.20
|
| Rate for Payer: Cash Price |
$4,612.95
|
| Rate for Payer: Central Health Plan Commercial |
$8,200.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,100.40
|
| Rate for Payer: Galaxy Health WC |
$8,713.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,225.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,837.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,905.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,345.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,050.20
|
| Rate for Payer: Multiplan Commercial |
$7,688.25
|
| Rate for Payer: Networks By Design Commercial |
$6,663.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,713.35
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN
|
Facility
|
OP
|
$1,383.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
905601804
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$96.66 |
| Max. Negotiated Rate |
$1,244.70 |
| Rate for Payer: Adventist Health Commercial |
$567.03
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$839.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,106.40
|
| Rate for Payer: Cigna of CA HMO |
$885.12
|
| Rate for Payer: Cigna of CA PPO |
$1,023.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$1,175.55
|
| Rate for Payer: Global Benefits Group Commercial |
$829.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,244.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$922.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$1,037.25
|
| Rate for Payer: Networks By Design Commercial |
$898.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$1,175.55
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$829.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN
|
Facility
|
IP
|
$1,383.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
905601804
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$276.60 |
| Max. Negotiated Rate |
$1,244.70 |
| Rate for Payer: Adventist Health Commercial |
$276.60
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$553.20
|
| Rate for Payer: EPIC Health Plan Senior |
$553.20
|
| Rate for Payer: Galaxy Health WC |
$1,175.55
|
| Rate for Payer: Global Benefits Group Commercial |
$829.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,244.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$922.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$856.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.60
|
| Rate for Payer: Multiplan Commercial |
$1,037.25
|
| Rate for Payer: Networks By Design Commercial |
$898.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,175.55
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN MCAL
|
Facility
|
IP
|
$1,383.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
907000032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$276.60 |
| Max. Negotiated Rate |
$1,244.70 |
| Rate for Payer: Adventist Health Commercial |
$276.60
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$553.20
|
| Rate for Payer: EPIC Health Plan Senior |
$553.20
|
| Rate for Payer: Galaxy Health WC |
$1,175.55
|
| Rate for Payer: Global Benefits Group Commercial |
$829.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,244.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$922.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$856.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.60
|
| Rate for Payer: Multiplan Commercial |
$1,037.25
|
| Rate for Payer: Networks By Design Commercial |
$898.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,175.55
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN MCAL
|
Facility
|
OP
|
$1,383.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
907000032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$96.66 |
| Max. Negotiated Rate |
$1,244.70 |
| Rate for Payer: Adventist Health Commercial |
$567.03
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$839.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,106.40
|
| Rate for Payer: Cigna of CA HMO |
$885.12
|
| Rate for Payer: Cigna of CA PPO |
$1,023.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$1,175.55
|
| Rate for Payer: Global Benefits Group Commercial |
$829.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,244.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$922.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$1,037.25
|
| Rate for Payer: Networks By Design Commercial |
$898.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$1,175.55
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$829.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC NEUROINTERVENTIONAL CATH J&J
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Central Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: EPIC Health Plan Senior |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
|
|
HC NEUROINTERVENTIONAL CATH J&J
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.05
|
| Rate for Payer: Blue Shield of California Commercial |
$84.32
|
| Rate for Payer: Blue Shield of California EPN |
$55.06
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Central Health Plan Commercial |
$110.40
|
| Rate for Payer: Cigna of CA HMO |
$88.32
|
| Rate for Payer: Cigna of CA PPO |
$102.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: EPIC Health Plan Senior |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.20
|
| Rate for Payer: InnovAge PACE Commercial |
$69.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
| Rate for Payer: Riverside University Health System MISP |
$55.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.00
|
| Rate for Payer: United Healthcare All Other HMO |
$69.00
|
| Rate for Payer: United Healthcare HMO Rider |
$69.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.30
|
| Rate for Payer: Vantage Medical Group Senior |
$117.30
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
IP
|
$8,508.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,701.60 |
| Max. Negotiated Rate |
$7,657.20 |
| Rate for Payer: Adventist Health Commercial |
$1,701.60
|
| Rate for Payer: Cash Price |
$3,828.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,806.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,403.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,403.20
|
| Rate for Payer: Galaxy Health WC |
$7,231.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,104.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,657.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,674.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,241.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,266.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,701.60
|
| Rate for Payer: Multiplan Commercial |
$6,381.00
|
| Rate for Payer: Networks By Design Commercial |
$5,530.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,231.80
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
IP
|
$8,508.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,701.60 |
| Max. Negotiated Rate |
$7,657.20 |
| Rate for Payer: Adventist Health Commercial |
$1,701.60
|
| Rate for Payer: Cash Price |
$3,828.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,806.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,403.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,403.20
|
| Rate for Payer: Galaxy Health WC |
$7,231.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,104.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,657.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,674.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,241.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,266.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,701.60
|
| Rate for Payer: Multiplan Commercial |
$6,381.00
|
| Rate for Payer: Networks By Design Commercial |
$5,530.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,231.80
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
OP
|
$4,666.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$202.99 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$933.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,732.80
|
| Rate for Payer: Cigna of CA HMO |
$2,986.24
|
| Rate for Payer: Cigna of CA PPO |
$3,452.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$3,966.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,799.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,199.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$202.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,112.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$3,499.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$3,032.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,966.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,799.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
OP
|
$4,666.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$202.99 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$933.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,732.80
|
| Rate for Payer: Cigna of CA HMO |
$2,986.24
|
| Rate for Payer: Cigna of CA PPO |
$3,452.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$3,966.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,799.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,199.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$202.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,112.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$3,499.50
|
| Rate for Payer: Networks By Design Commercial |
$3,032.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,966.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,799.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,357.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC NEUROMUSC RE-ED 15 MIN OT
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905104141
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$104.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$190.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: Cigna of CA HMO |
$162.56
|
| Rate for Payer: Cigna of CA PPO |
$187.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$215.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.02
|
| Rate for Payer: InnovAge PACE Commercial |
$127.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177.80
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
| Rate for Payer: Riverside University Health System MISP |
$101.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.90
|
| Rate for Payer: Vantage Medical Group Senior |
$215.90
|
|
|
HC NEUROMUSC RE-ED 15 MIN OT
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905104141
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
|
