|
HC REVISION OF EYELID
|
Facility
|
IP
|
$4,538.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$907.60 |
| Max. Negotiated Rate |
$4,084.20 |
| Rate for Payer: Cash Price |
$2,042.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,630.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,815.20
|
| Rate for Payer: Galaxy Health WC |
$3,857.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,722.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,084.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,026.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,728.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$907.60
|
| Rate for Payer: Multiplan Commercial |
$3,403.50
|
| Rate for Payer: Networks By Design Commercial |
$2,949.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,857.30
|
|
|
HC REVISION OF EYELID
|
Facility
|
OP
|
$4,538.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.98 |
| Max. Negotiated Rate |
$4,084.20 |
| 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 |
$545.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,722.80
|
| Rate for Payer: Caremore Medicare Advantage |
$363.98
|
| Rate for Payer: Cash Price |
$2,042.10
|
| Rate for Payer: Cash Price |
$2,042.10
|
| Rate for Payer: Cash Price |
$2,042.10
|
| Rate for Payer: Cash Price |
$2,042.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,630.40
|
| Rate for Payer: Cigna of CA PPO |
$3,358.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Media |
$363.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| Rate for Payer: Galaxy Health WC |
$3,857.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,722.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,084.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,403.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$596.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$363.98
|
| Rate for Payer: InnovAge PACE Commercial |
$545.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,026.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$907.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$487.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| Rate for Payer: Multiplan Commercial |
$3,403.50
|
| Rate for Payer: Networks By Design Commercial |
$2,949.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,857.30
|
| Rate for Payer: Prime Health Services Medicare |
$385.82
|
| Rate for Payer: Riverside University Health System MISP |
$400.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,722.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,269.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,269.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,269.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC REV KNUCKLE BENDER W/OUTRIGGER
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
903203944
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$204.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.11
|
| Rate for Payer: Blue Distinction Transplant |
$136.20
|
| Rate for Payer: Blue Shield of California Commercial |
$170.25
|
| Rate for Payer: Blue Shield of California EPN |
$123.49
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Central Health Plan Commercial |
$181.60
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.95
|
| Rate for Payer: Dignity Health Media |
$192.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$170.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$79.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.07
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: Networks By Design Commercial |
$113.50
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: Riverside University Health System MISP |
$90.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.50
|
| Rate for Payer: United Healthcare All Other HMO |
$113.50
|
| Rate for Payer: United Healthcare HMO Rider |
$113.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.95
|
| Rate for Payer: Vantage Medical Group Senior |
$192.95
|
|
|
HC REV KNUCKLE BENDER W/OUTRIGGER
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
903203944
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$204.30 |
| Rate for Payer: Blue Shield of California EPN |
$121.22
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Central Health Plan Commercial |
$181.60
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.40
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: Networks By Design Commercial |
$113.50
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.72
|
| Rate for Payer: United Healthcare All Other HMO |
$83.72
|
| Rate for Payer: United Healthcare HMO Rider |
$81.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.91
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
IP
|
$6,415.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,283.00 |
| Max. Negotiated Rate |
$5,773.50 |
| Rate for Payer: Cash Price |
$2,886.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,132.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,566.00
|
| Rate for Payer: Galaxy Health WC |
$5,452.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,849.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,773.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,278.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,444.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,283.00
|
| Rate for Payer: Multiplan Commercial |
$4,811.25
|
| Rate for Payer: Networks By Design Commercial |
$4,169.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,452.75
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
OP
|
$6,415.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$867.90 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,412.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,849.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,412.38
|
| Rate for Payer: Cash Price |
$2,886.75
|
| Rate for Payer: Cash Price |
$2,886.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,132.00
|
| Rate for Payer: Cigna of CA PPO |
$4,747.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$5,452.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,849.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,773.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,811.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,980.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: InnovAge PACE Commercial |
$3,618.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,278.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,283.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,232.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$4,811.25
|
| Rate for Payer: Networks By Design Commercial |
$4,169.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,452.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,557.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,653.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,849.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
OP
|
$3,304.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,808.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,817.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,817.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,982.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Cigna of CA PPO |
$2,444.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,808.40
|
| Rate for Payer: Dignity Health Media |
$2,808.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,808.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,321.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,321.60
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,478.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,156.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,203.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,321.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,982.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,808.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,808.40
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
IP
|
$3,304.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.80 |
| Max. Negotiated Rate |
$2,973.60 |
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,321.60
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,203.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,258.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
OP
|
$3,304.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.49 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,808.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,817.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,817.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,982.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Cigna of CA PPO |
$2,444.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,808.40
|
| Rate for Payer: Dignity Health Media |
$2,808.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,808.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,321.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,321.60
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,478.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,156.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,203.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,321.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,982.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,808.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,808.40
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
IP
|
$3,304.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.80 |
| Max. Negotiated Rate |
$2,973.60 |
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,321.60
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,203.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,258.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
|
OP
|
$5,438.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$378.82 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,412.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,262.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,412.38
|
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,350.40
|
| Rate for Payer: Cigna of CA PPO |
$4,024.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$4,622.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,894.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,078.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,980.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: InnovAge PACE Commercial |
$3,618.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,627.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,232.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$4,078.50
|
| Rate for Payer: Networks By Design Commercial |
$3,534.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,622.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,557.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,653.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
|
IP
|
$5,438.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,087.60 |
| Max. Negotiated Rate |
$4,894.20 |
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,350.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,175.20
|
| Rate for Payer: Galaxy Health WC |
$4,622.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,894.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,627.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,071.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.60
|
| Rate for Payer: Multiplan Commercial |
$4,078.50
|
| Rate for Payer: Networks By Design Commercial |
$3,534.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,622.30
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
|
OP
|
$5,438.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$371.15 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,412.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,262.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,412.38
|
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,350.40
|
| Rate for Payer: Cigna of CA PPO |
$4,024.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$4,622.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,894.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,078.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,980.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: InnovAge PACE Commercial |
$3,618.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,627.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,232.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$4,078.50
|
| Rate for Payer: Networks By Design Commercial |
$3,534.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,622.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,557.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,653.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
|
IP
|
$5,438.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,087.60 |
| Max. Negotiated Rate |
$4,894.20 |
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,350.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,175.20
|
| Rate for Payer: Galaxy Health WC |
$4,622.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,894.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,627.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,071.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.60
|
| Rate for Payer: Multiplan Commercial |
$4,078.50
|
| Rate for Payer: Networks By Design Commercial |
$3,534.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,622.30
|
|
|
HC RF MAGNETIC-GUIDE AV FISTULA
|
Facility
|
OP
|
$29,578.00
|
|
|
Service Code
|
CPT G2171
|
| Hospital Charge Code |
909000755
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,465.14 |
| Max. Negotiated Rate |
$26,620.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,962.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,141.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,267.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,267.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$17,746.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$13,310.10
|
| Rate for Payer: Cash Price |
$13,310.10
|
| Rate for Payer: Cash Price |
$13,310.10
|
| Rate for Payer: Central Health Plan Commercial |
$23,662.40
|
| Rate for Payer: Cigna of CA PPO |
$21,887.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,141.30
|
| Rate for Payer: Dignity Health Media |
$25,141.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,141.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,831.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,831.20
|
| Rate for Payer: Galaxy Health WC |
$25,141.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17,746.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,620.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22,183.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,352.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,728.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,269.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,915.60
|
| Rate for Payer: Multiplan Commercial |
$22,183.50
|
| Rate for Payer: Networks By Design Commercial |
$19,225.70
|
| Rate for Payer: Prime Health Services Commercial |
$25,141.30
|
| Rate for Payer: Riverside University Health System MISP |
$11,831.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,746.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,789.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,789.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,789.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,789.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,141.30
|
| Rate for Payer: Vantage Medical Group Senior |
$25,141.30
|
|
|
HC RF MAGNETIC-GUIDE AV FISTULA
|
Facility
|
IP
|
$29,578.00
|
|
|
Service Code
|
CPT G2171
|
| Hospital Charge Code |
909000755
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,915.60 |
| Max. Negotiated Rate |
$26,620.20 |
| Rate for Payer: Cash Price |
$13,310.10
|
| Rate for Payer: Central Health Plan Commercial |
$23,662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,831.20
|
| Rate for Payer: Galaxy Health WC |
$25,141.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17,746.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,620.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,728.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,269.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,915.60
|
| Rate for Payer: Multiplan Commercial |
$22,183.50
|
| Rate for Payer: Networks By Design Commercial |
$19,225.70
|
| Rate for Payer: Prime Health Services Commercial |
$25,141.30
|
|
|
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 |
$1,086.05 |
| Max. Negotiated Rate |
$2,792.70 |
| 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 |
$1,706.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,502.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,833.25
|
| Rate for Payer: Blue Distinction Transplant |
$1,861.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,327.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,688.03
|
| 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 Media |
$2,637.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,637.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,241.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,327.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,086.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,069.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,266.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,272.23
|
| 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 |
$1,551.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,551.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,551.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,551.50
|
| 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 |
905352628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$620.60 |
| Max. Negotiated Rate |
$2,792.70 |
| Rate for Payer: Blue Shield of California EPN |
$1,657.00
|
| 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: EPIC Health Plan Commercial |
$1,241.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$2,069.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,182.24
|
| 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 |
$1,551.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,637.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,171.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,144.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,119.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,023.99
|
|
|
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 |
$1,028.30 |
| Max. Negotiated Rate |
$2,644.20 |
| 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 |
$1,615.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,422.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,735.77
|
| Rate for Payer: Blue Distinction Transplant |
$1,762.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,203.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,598.27
|
| 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 Media |
$2,497.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,497.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,203.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,028.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,661.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.58
|
| 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 |
$1,469.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,469.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,469.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,469.00
|
| 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: Blue Shield of California EPN |
$1,568.89
|
| 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: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.38
|
| 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 |
$1,469.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,109.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1,083.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,060.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$969.54
|
|
|
HC RH BLOOD GROUP
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.92
|
| Rate for Payer: Blue Distinction Transplant |
$75.00
|
| Rate for Payer: Blue Shield of California Commercial |
$77.25
|
| Rate for Payer: Blue Shield of California EPN |
$60.75
|
| Rate for Payer: Caremore Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$93.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$82.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: InnovAge PACE Commercial |
$75.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Prime Health Services Medicare |
$53.12
|
| Rate for Payer: Riverside University Health System MISP |
$55.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC RH BLOOD GROUP
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
|
OP
|
$24,258.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906811404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,071.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,471.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$14,554.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,071.36
|
| Rate for Payer: Cash Price |
$10,916.10
|
| Rate for Payer: Cash Price |
$10,916.10
|
| Rate for Payer: Cash Price |
$10,916.10
|
| Rate for Payer: Central Health Plan Commercial |
$19,406.40
|
| Rate for Payer: Cigna of CA PPO |
$17,950.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$20,619.30
|
| Rate for Payer: Global Benefits Group Commercial |
$14,554.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,832.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,193.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,717.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: InnovAge PACE Commercial |
$6,107.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,121.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,851.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,455.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$18,193.50
|
| Rate for Payer: Networks By Design Commercial |
$15,767.70
|
| Rate for Payer: Prime Health Services Commercial |
$20,619.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,315.64
|
| Rate for Payer: Riverside University Health System MISP |
$4,478.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,554.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
|
IP
|
$24,258.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906811404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,851.60 |
| Max. Negotiated Rate |
$21,832.20 |
| Rate for Payer: Cash Price |
$10,916.10
|
| Rate for Payer: Central Health Plan Commercial |
$19,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,703.20
|
| Rate for Payer: Galaxy Health WC |
$20,619.30
|
| Rate for Payer: Global Benefits Group Commercial |
$14,554.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,832.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,242.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,851.60
|
| Rate for Payer: Multiplan Commercial |
$18,193.50
|
| Rate for Payer: Networks By Design Commercial |
$15,767.70
|
| Rate for Payer: Prime Health Services Commercial |
$20,619.30
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
|
IP
|
$24,258.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906820062
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,851.60 |
| Max. Negotiated Rate |
$21,832.20 |
| Rate for Payer: Cash Price |
$10,916.10
|
| Rate for Payer: Central Health Plan Commercial |
$19,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,703.20
|
| Rate for Payer: Galaxy Health WC |
$20,619.30
|
| Rate for Payer: Global Benefits Group Commercial |
$14,554.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,832.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,242.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,851.60
|
| Rate for Payer: Multiplan Commercial |
$18,193.50
|
| Rate for Payer: Networks By Design Commercial |
$15,767.70
|
| Rate for Payer: Prime Health Services Commercial |
$20,619.30
|
|
