|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
IP
|
$8,484.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,696.80 |
| Max. Negotiated Rate |
$7,635.60 |
| Rate for Payer: Adventist Health Commercial |
$1,696.80
|
| Rate for Payer: Cash Price |
$3,817.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,787.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,938.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,393.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,393.60
|
| Rate for Payer: Galaxy Health WC |
$7,211.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,090.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,635.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,387.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,005.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,696.80
|
| Rate for Payer: Multiplan Commercial |
$6,363.00
|
| Rate for Payer: Networks By Design Commercial |
$5,514.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,211.40
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$3,933.00 |
| Rate for Payer: Adventist Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,496.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,059.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,748.00
|
| Rate for Payer: Galaxy Health WC |
$3,714.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,622.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,933.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,774.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,578.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.00
|
| Rate for Payer: Multiplan Commercial |
$3,277.50
|
| Rate for Payer: Networks By Design Commercial |
$2,840.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,714.50
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.17 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$874.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,403.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,277.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,496.00
|
| Rate for Payer: Cigna of CA HMO |
$2,796.80
|
| Rate for Payer: Cigna of CA PPO |
$3,233.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,714.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,714.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,059.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,748.00
|
| Rate for Payer: Galaxy Health WC |
$3,714.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,622.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,933.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,774.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,578.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,059.00
|
| Rate for Payer: Multiplan Commercial |
$3,277.50
|
| Rate for Payer: Networks By Design Commercial |
$2,840.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,714.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,748.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,622.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,185.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,714.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,714.50
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.37 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$874.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,403.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,277.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,496.00
|
| Rate for Payer: Cigna of CA HMO |
$2,796.80
|
| Rate for Payer: Cigna of CA PPO |
$3,233.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,714.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,714.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,059.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,748.00
|
| Rate for Payer: Galaxy Health WC |
$3,714.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,622.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,933.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,774.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,578.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,059.00
|
| Rate for Payer: Multiplan Commercial |
$3,277.50
|
| Rate for Payer: Networks By Design Commercial |
$2,840.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,714.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,748.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,622.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,185.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,714.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,714.50
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$3,933.00 |
| Rate for Payer: Adventist Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,496.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,059.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,748.00
|
| Rate for Payer: Galaxy Health WC |
$3,714.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,622.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,933.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,774.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,578.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.00
|
| Rate for Payer: Multiplan Commercial |
$3,277.50
|
| Rate for Payer: Networks By Design Commercial |
$2,840.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,714.50
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
|
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$343.23 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,511.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,953.34
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,753.60
|
| Rate for Payer: Cigna of CA HMO |
$4,602.88
|
| Rate for Payer: Cigna of CA PPO |
$5,322.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,034.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$6,113.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,472.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$343.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,566.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$379.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$4,674.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Commercial |
$6,113.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,662.22
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,762.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,315.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,596.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
|
IP
|
$7,192.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,438.40 |
| Max. Negotiated Rate |
$6,472.80 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,753.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,034.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,876.80
|
| Rate for Payer: Galaxy Health WC |
$6,113.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,472.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,566.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,243.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.40
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Networks By Design Commercial |
$4,674.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,113.20
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
|
IP
|
$7,192.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,438.40 |
| Max. Negotiated Rate |
$6,472.80 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,753.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,034.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,876.80
|
| Rate for Payer: Galaxy Health WC |
$6,113.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,472.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,566.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,243.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.40
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Networks By Design Commercial |
$4,674.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,113.20
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
|
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$336.19 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,511.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,953.34
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,753.60
|
| Rate for Payer: Cigna of CA HMO |
$4,602.88
|
| Rate for Payer: Cigna of CA PPO |
$5,322.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,034.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$6,113.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,472.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$336.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,566.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$4,674.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Commercial |
$6,113.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,662.22
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,762.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,315.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,596.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC RF MAGNETIC-GUIDE AV FISTULA
|
Facility
|
OP
|
$23,884.00
|
|
|
Service Code
|
CPT G2171
|
| Hospital Charge Code |
909000755
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,776.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,776.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,301.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,136.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,913.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$10,747.80
|
| Rate for Payer: Cash Price |
$10,747.80
|
| Rate for Payer: Central Health Plan Commercial |
$19,107.20
|
| Rate for Payer: Cigna of CA HMO |
$15,285.76
|
| Rate for Payer: Cigna of CA PPO |
$17,674.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,301.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,301.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,301.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,718.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,553.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,553.60
|
| Rate for Payer: Galaxy Health WC |
$20,301.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14,330.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,495.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,166.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,669.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,091.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,776.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,718.80
|
| Rate for Payer: Multiplan Commercial |
$17,913.00
|
| Rate for Payer: Networks By Design Commercial |
$15,524.60
|
| Rate for Payer: Prime Health Services Commercial |
$20,301.40
|
| Rate for Payer: Riverside University Health System MISP |
$9,553.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,330.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,942.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,942.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,942.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,942.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,301.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,301.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20,301.40
|
|
|
HC RF MAGNETIC-GUIDE AV FISTULA
|
Facility
|
IP
|
$23,884.00
|
|
|
Service Code
|
CPT G2171
|
| Hospital Charge Code |
909000755
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,776.80 |
| Max. Negotiated Rate |
$21,495.60 |
| Rate for Payer: Adventist Health Commercial |
$4,776.80
|
| Rate for Payer: Cash Price |
$10,747.80
|
| Rate for Payer: Central Health Plan Commercial |
$19,107.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,718.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,553.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,553.60
|
| Rate for Payer: Galaxy Health WC |
$20,301.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14,330.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,495.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,166.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,091.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,776.80
|
| Rate for Payer: Multiplan Commercial |
$17,913.00
|
| Rate for Payer: Networks By Design Commercial |
$15,524.60
|
| Rate for Payer: Prime Health Services Commercial |
$20,301.40
|
|
|
HC RGO HIP JT AND CABLES, FRAME
|
Facility
|
OP
|
$3,103.00
|
|
|
Service Code
|
CPT L2628
|
| Hospital Charge Code |
915352628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,016.23 |
| Max. Negotiated Rate |
$2,792.70 |
| Rate for Payer: Adventist Health Commercial |
$1,272.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,706.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,327.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,805.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2,488.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,563.91
|
| Rate for Payer: Cash Price |
$1,396.35
|
| Rate for Payer: Cash Price |
$1,396.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,482.40
|
| Rate for Payer: Cigna of CA HMO |
$2,172.10
|
| Rate for Payer: Cigna of CA PPO |
$2,172.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,637.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,637.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,172.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,241.20
|
| Rate for Payer: Galaxy Health WC |
$2,637.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,861.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,792.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,146.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,970.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,266.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,830.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,272.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,172.10
|
| Rate for Payer: Multiplan Commercial |
$2,327.25
|
| Rate for Payer: Networks By Design Commercial |
$1,551.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,637.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,241.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,861.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,861.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,164.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,133.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,016.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,637.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,637.55
|
|
|
HC RGO HIP JT AND CABLES, FRAME
|
Facility
|
OP
|
$3,103.00
|
|
|
Service Code
|
CPT L2628
|
| Hospital Charge Code |
905352628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,016.23 |
| Max. Negotiated Rate |
$2,792.70 |
| Rate for Payer: Adventist Health Commercial |
$1,272.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,706.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,327.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,805.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2,488.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,563.91
|
| Rate for Payer: Cash Price |
$1,396.35
|
| Rate for Payer: Cash Price |
$1,396.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,482.40
|
| Rate for Payer: Cigna of CA HMO |
$2,172.10
|
| Rate for Payer: Cigna of CA PPO |
$2,172.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,637.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,637.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,172.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,241.20
|
| Rate for Payer: Galaxy Health WC |
$2,637.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,861.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,792.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,146.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,970.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,266.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,830.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,272.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,172.10
|
| Rate for Payer: Multiplan Commercial |
$2,327.25
|
| Rate for Payer: Networks By Design Commercial |
$1,551.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,637.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,241.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,861.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,861.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,164.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,133.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,016.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,637.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,637.55
|
|
|
HC RGO HIP JT AND CABLES, FRAME
|
Facility
|
IP
|
$3,103.00
|
|
|
Service Code
|
CPT L2628
|
| Hospital Charge Code |
915352628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$620.60 |
| Max. Negotiated Rate |
$2,792.70 |
| Rate for Payer: Adventist Health Commercial |
$620.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,488.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,563.91
|
| Rate for Payer: Cash Price |
$1,396.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,482.40
|
| Rate for Payer: Cigna of CA HMO |
$2,172.10
|
| Rate for Payer: Cigna of CA PPO |
$2,172.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,172.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,241.20
|
| Rate for Payer: Galaxy Health WC |
$2,637.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,861.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,792.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,970.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,830.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$620.60
|
| Rate for Payer: Multiplan Commercial |
$2,327.25
|
| Rate for Payer: Networks By Design Commercial |
$2,016.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,637.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,164.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,133.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,016.23
|
|
|
HC RGO HIP JT AND CABLES, FRAME
|
Facility
|
IP
|
$3,103.00
|
|
|
Service Code
|
CPT L2628
|
| Hospital Charge Code |
905352628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$620.60 |
| Max. Negotiated Rate |
$2,792.70 |
| Rate for Payer: Adventist Health Commercial |
$620.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,488.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,563.91
|
| Rate for Payer: Cash Price |
$1,396.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,482.40
|
| Rate for Payer: Cigna of CA HMO |
$2,172.10
|
| Rate for Payer: Cigna of CA PPO |
$2,172.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,172.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,241.20
|
| Rate for Payer: Galaxy Health WC |
$2,637.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,861.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,792.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,970.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,830.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$620.60
|
| Rate for Payer: Multiplan Commercial |
$2,327.25
|
| Rate for Payer: Networks By Design Commercial |
$2,016.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,637.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,164.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,133.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,016.23
|
|
|
HC RGO HIP JT AND CABLES, MOLDED
|
Facility
|
OP
|
$2,938.00
|
|
|
Service Code
|
CPT L2627
|
| Hospital Charge Code |
905352627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$962.20 |
| Max. Negotiated Rate |
$2,644.20 |
| Rate for Payer: Adventist Health Commercial |
$1,204.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,615.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,203.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,709.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,356.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,480.75
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,350.40
|
| Rate for Payer: Cigna of CA HMO |
$2,056.60
|
| Rate for Payer: Cigna of CA PPO |
$2,056.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,497.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,497.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,056.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.20
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,644.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,504.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,865.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,661.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,733.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,056.60
|
| Rate for Payer: Multiplan Commercial |
$2,203.50
|
| Rate for Payer: Networks By Design Commercial |
$1,469.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,175.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,497.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,497.30
|
|
|
HC RGO HIP JT AND CABLES, MOLDED
|
Facility
|
IP
|
$2,938.00
|
|
|
Service Code
|
CPT L2627
|
| Hospital Charge Code |
905352627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.60 |
| Max. Negotiated Rate |
$2,644.20 |
| Rate for Payer: Adventist Health Commercial |
$587.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,356.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,480.75
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,350.40
|
| Rate for Payer: Cigna of CA HMO |
$2,056.60
|
| Rate for Payer: Cigna of CA PPO |
$2,056.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,056.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.20
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,644.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,865.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,733.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.60
|
| Rate for Payer: Multiplan Commercial |
$2,203.50
|
| Rate for Payer: Networks By Design Commercial |
$1,909.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.20
|
|
|
HC RGO HIP JT AND CABLES, MOLDED
|
Facility
|
IP
|
$2,938.00
|
|
|
Service Code
|
CPT L2627
|
| Hospital Charge Code |
915352627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.60 |
| Max. Negotiated Rate |
$2,644.20 |
| Rate for Payer: Adventist Health Commercial |
$587.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,356.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,480.75
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,350.40
|
| Rate for Payer: Cigna of CA HMO |
$2,056.60
|
| Rate for Payer: Cigna of CA PPO |
$2,056.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,056.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.20
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,644.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,865.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,733.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.60
|
| Rate for Payer: Multiplan Commercial |
$2,203.50
|
| Rate for Payer: Networks By Design Commercial |
$1,909.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.20
|
|
|
HC RGO HIP JT AND CABLES, MOLDED
|
Facility
|
OP
|
$2,938.00
|
|
|
Service Code
|
CPT L2627
|
| Hospital Charge Code |
915352627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$962.20 |
| Max. Negotiated Rate |
$2,644.20 |
| Rate for Payer: Adventist Health Commercial |
$1,204.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,615.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,203.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,709.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,356.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,480.75
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,350.40
|
| Rate for Payer: Cigna of CA HMO |
$2,056.60
|
| Rate for Payer: Cigna of CA PPO |
$2,056.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,497.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,497.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,056.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.20
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,644.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,504.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,865.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,661.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,733.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,056.60
|
| Rate for Payer: Multiplan Commercial |
$2,203.50
|
| Rate for Payer: Networks By Design Commercial |
$1,469.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,175.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,497.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,497.30
|
|
|
HC RHABDOMYOSARCOMABY RT-PCR
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
903800239
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Adventist Health Commercial |
$67.60
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Central Health Plan Commercial |
$270.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$236.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$135.20
|
| Rate for Payer: Galaxy Health WC |
$287.30
|
| Rate for Payer: Global Benefits Group Commercial |
$202.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$304.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$199.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.60
|
| Rate for Payer: Multiplan Commercial |
$253.50
|
| Rate for Payer: Networks By Design Commercial |
$219.70
|
| Rate for Payer: Prime Health Services Commercial |
$287.30
|
|
|
HC RHABDOMYOSARCOMABY RT-PCR
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
903800239
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$320.02 |
| Rate for Payer: Adventist Health Commercial |
$67.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$137.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$239.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$230.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.02
|
| Rate for Payer: Blue Shield of California Commercial |
$212.94
|
| Rate for Payer: Blue Shield of California EPN |
$134.19
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Central Health Plan Commercial |
$270.40
|
| Rate for Payer: Cigna of CA HMO |
$216.32
|
| Rate for Payer: Cigna of CA PPO |
$250.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$236.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.05
|
| Rate for Payer: EPIC Health Plan Senior |
$150.70
|
| Rate for Payer: Galaxy Health WC |
$287.30
|
| Rate for Payer: Global Benefits Group Commercial |
$202.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$304.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$224.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$235.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$253.50
|
| Rate for Payer: Networks By Design Commercial |
$219.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$287.30
|
| Rate for Payer: Prime Health Services Medicare |
$145.22
|
| Rate for Payer: Riverside University Health System MISP |
$150.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.97
|
| Rate for Payer: United Healthcare All Other HMO |
$110.97
|
| Rate for Payer: United Healthcare HMO Rider |
$110.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$137.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC RH BLOOD GROUP
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
|
|
HC RH BLOOD GROUP
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.73
|
| Rate for Payer: Blue Shield of California Commercial |
$73.71
|
| Rate for Payer: Blue Shield of California EPN |
$46.45
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$74.88
|
| Rate for Payer: Cigna of CA PPO |
$86.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3.29
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.99
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Medicare |
$3.17
|
| Rate for Payer: Riverside University Health System MISP |
$3.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
|
OP
|
$19,588.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906811404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,917.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,169.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$8,814.60
|
| Rate for Payer: Cash Price |
$8,814.60
|
| Rate for Payer: Cash Price |
$8,814.60
|
| Rate for Payer: Central Health Plan Commercial |
$15,670.40
|
| Rate for Payer: Cigna of CA HMO |
$12,732.20
|
| Rate for Payer: Cigna of CA PPO |
$14,495.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,711.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,879.96
|
| Rate for Payer: EPIC Health Plan Senior |
$4,586.64
|
| Rate for Payer: Galaxy Health WC |
$16,649.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,752.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,629.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,838.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,920.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,438.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,121.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,837.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,917.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,587.36
|
| Rate for Payer: Multiplan Commercial |
$14,691.00
|
| Rate for Payer: Networks By Design Commercial |
$12,732.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Prime Health Services Commercial |
$16,649.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,419.85
|
| Rate for Payer: Riverside University Health System MISP |
$4,586.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,752.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,794.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,169.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
|
IP
|
$19,588.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906811404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,917.60 |
| Max. Negotiated Rate |
$17,629.20 |
| Rate for Payer: Adventist Health Commercial |
$3,917.60
|
| Rate for Payer: Cash Price |
$8,814.60
|
| Rate for Payer: Central Health Plan Commercial |
$15,670.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,711.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,835.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,835.20
|
| Rate for Payer: Galaxy Health WC |
$16,649.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,752.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,629.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,438.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,556.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,917.60
|
| Rate for Payer: Multiplan Commercial |
$14,691.00
|
| Rate for Payer: Networks By Design Commercial |
$12,732.20
|
| Rate for Payer: Prime Health Services Commercial |
$16,649.80
|
|
