|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
OP
|
$1,459.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$875.40
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cigna of CA PPO |
$1,079.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,240.15
|
| Rate for Payer: Global Benefits Group Commercial |
$875.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,094.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,167.20
|
| Rate for Payer: Networks By Design Commercial |
$948.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,240.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$875.40
|
| 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 Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
IP
|
$1,459.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$350.16 |
| Max. Negotiated Rate |
$1,240.15 |
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$583.60
|
| Rate for Payer: Galaxy Health WC |
$1,240.15
|
| Rate for Payer: Global Benefits Group Commercial |
$875.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.16
|
| Rate for Payer: Multiplan Commercial |
$1,167.20
|
| Rate for Payer: Networks By Design Commercial |
$948.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,240.15
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
OP
|
$1,459.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$875.40
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cigna of CA PPO |
$1,079.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,240.15
|
| Rate for Payer: Global Benefits Group Commercial |
$875.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,094.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,167.20
|
| Rate for Payer: Networks By Design Commercial |
$948.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,240.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$875.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$729.50
|
| Rate for Payer: United Healthcare All Other HMO |
$729.50
|
| Rate for Payer: United Healthcare HMO Rider |
$729.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$729.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJECT W/FLUOR, EVAL CV DEVICE
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
909081842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$764.40
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Cigna of CA PPO |
$942.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$1,082.90
|
| Rate for Payer: Global Benefits Group Commercial |
$764.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$955.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$849.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$1,019.20
|
| Rate for Payer: Networks By Design Commercial |
$828.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,082.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$764.40
|
| 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 Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC INJECT W/FLUOR, EVAL CV DEVICE
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
909081842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$305.76 |
| Max. Negotiated Rate |
$1,082.90 |
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$509.60
|
| Rate for Payer: Galaxy Health WC |
$1,082.90
|
| Rate for Payer: Global Benefits Group Commercial |
$764.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$849.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.76
|
| Rate for Payer: Multiplan Commercial |
$1,019.20
|
| Rate for Payer: Networks By Design Commercial |
$828.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,082.90
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
OP
|
$3,008.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
909081856
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.68 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,556.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,654.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,654.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,804.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cigna of CA PPO |
$2,225.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,556.80
|
| Rate for Payer: Dignity Health Media |
$2,556.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,256.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.92
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,804.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,556.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,556.80
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
909081858
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$721.92 |
| Max. Negotiated Rate |
$2,556.80 |
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,146.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.92
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
OP
|
$3,008.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
909081858
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$253.23 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,556.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,654.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,654.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,804.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cigna of CA PPO |
$2,225.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,556.80
|
| Rate for Payer: Dignity Health Media |
$2,556.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,256.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.92
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,804.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,556.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,556.80
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
909081856
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$721.92 |
| Max. Negotiated Rate |
$2,556.80 |
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,146.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.92
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
|
|
HC INJ FORAMEN EPIDURAL C/T
|
Facility
|
OP
|
$3,008.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
909081855
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$293.55 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,804.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cigna of CA PPO |
$2,225.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,256.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,867.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,804.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ FORAMEN EPIDURAL C/T
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
909081855
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$721.92 |
| Max. Negotiated Rate |
$2,556.80 |
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,146.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.92
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
|
|
HC INJ FORAMEN EPIDURAL L/S
|
Facility
|
OP
|
$3,008.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
909081857
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$272.35 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,804.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cigna of CA PPO |
$2,225.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,256.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,867.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,804.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ FORAMEN EPIDURAL L/S
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
909081857
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$721.92 |
| Max. Negotiated Rate |
$2,556.80 |
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,146.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.92
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
|
|
HC INJ INTER CRV/THRC WGUID
|
Facility
|
OP
|
$3,310.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
907262321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$424.42 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,986.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cigna of CA PPO |
$2,449.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$2,813.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,986.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,482.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,207.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$794.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$2,648.00
|
| Rate for Payer: Networks By Design Commercial |
$2,151.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,813.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,986.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INJ INTER CRV/THRC WGUID
|
Facility
|
IP
|
$3,310.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
907262321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$794.40 |
| Max. Negotiated Rate |
$2,813.50 |
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,324.00
|
| Rate for Payer: Galaxy Health WC |
$2,813.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,986.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,207.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,261.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$794.40
|
| Rate for Payer: Multiplan Commercial |
$2,648.00
|
| Rate for Payer: Networks By Design Commercial |
$2,151.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,813.50
|
|
|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
OP
|
$3,008.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$280.82 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,804.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cigna of CA PPO |
$2,225.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,256.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,804.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$721.92 |
| Max. Negotiated Rate |
$2,556.80 |
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,146.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.92
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
|
|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
IP
|
$3,774.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$905.76 |
| Max. Negotiated Rate |
$3,207.90 |
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,509.60
|
| Rate for Payer: Galaxy Health WC |
$3,207.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,264.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,517.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,437.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.76
|
| Rate for Payer: Multiplan Commercial |
$3,019.20
|
| Rate for Payer: Networks By Design Commercial |
$2,453.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,207.90
|
|
|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
OP
|
$3,774.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$418.06 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,264.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: Cigna of CA PPO |
$2,792.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$3,207.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,264.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,830.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,517.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$3,019.20
|
| Rate for Payer: Networks By Design Commercial |
$2,453.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,207.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,264.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INJ INTER LMBR/SAC WO GUID
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$721.92 |
| Max. Negotiated Rate |
$2,556.80 |
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,146.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.92
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
|
|
HC INJ INTER LMBR/SAC WO GUID
|
Facility
|
OP
|
$3,008.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$263.15 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,804.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cigna of CA PPO |
$2,225.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,256.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,867.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,804.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ NEURO SUB W WO THRPTC SUB EPDRL, LMBR, SCRL
|
Facility
|
IP
|
$2,484.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
909000282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$596.16 |
| Max. Negotiated Rate |
$2,111.40 |
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$993.60
|
| Rate for Payer: Galaxy Health WC |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,656.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.16
|
| Rate for Payer: Multiplan Commercial |
$1,987.20
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
|
|
HC INJ NEURO SUB W WO THRPTC SUB EPDRL, LMBR, SCRL
|
Facility
|
OP
|
$2,484.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
909000282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$255.36 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,490.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Cigna of CA PPO |
$1,838.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,863.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,867.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,656.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$1,987.20
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,490.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ PROC FOR NEPH LOOP STENT GRAM
|
Facility
|
OP
|
$2,637.00
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
909000167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.41 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$853.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,582.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,186.65
|
| Rate for Payer: Cash Price |
$1,186.65
|
| Rate for Payer: Cigna of CA PPO |
$1,951.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Dignity Health Media |
$853.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$853.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$853.50
|
| Rate for Payer: Galaxy Health WC |
$2,241.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,977.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,399.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,382.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,382.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$853.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,758.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$853.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,143.69
|
| Rate for Payer: Multiplan Commercial |
$2,109.60
|
| Rate for Payer: Networks By Design Commercial |
$1,714.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,241.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,582.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Vantage Medical Group Senior |
$853.50
|
|
|
HC INJ PROC FOR NEPH LOOP STENT GRAM
|
Facility
|
IP
|
$2,637.00
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
909000167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$632.88 |
| Max. Negotiated Rate |
$2,241.45 |
| Rate for Payer: Cash Price |
$1,186.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,054.80
|
| Rate for Payer: Galaxy Health WC |
$2,241.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,758.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,004.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.88
|
| Rate for Payer: Multiplan Commercial |
$2,109.60
|
| Rate for Payer: Networks By Design Commercial |
$1,714.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,241.45
|
|
