|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$416.50 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$326.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$303.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Networks By Design Commercial |
$318.50
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
|
|
HC INJECTION ADMIN SYNAGIS
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
912190471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$62.05 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.20
|
| Rate for Payer: EPIC Health Plan Senior |
$29.20
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
|
|
HC INJECTION ADMIN SYNAGIS
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
912190471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$148.31 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.83
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.50
|
| Rate for Payer: United Healthcare All Other HMO |
$36.50
|
| Rate for Payer: United Healthcare HMO Rider |
$36.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC INJECTION EYE DRUG
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
900501532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.20 |
| Max. Negotiated Rate |
$1,173.85 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Cash Price |
$759.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$552.40
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$854.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.44
|
| Rate for Payer: Multiplan Commercial |
$1,104.80
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
|
|
HC INJECTION EYE DRUG
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
900501532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$759.55
|
| Rate for Payer: Cash Price |
$759.55
|
| Rate for Payer: Cash Price |
$759.55
|
| Rate for Payer: Cigna of CA HMO |
$883.84
|
| Rate for Payer: Cigna of CA PPO |
$1,021.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$1,104.80
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$828.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$690.50
|
| Rate for Payer: United Healthcare All Other HMO |
$690.50
|
| Rate for Payer: United Healthcare HMO Rider |
$690.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$690.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC INJECTION FACIAL NERVE
|
Facility
|
IP
|
$1,638.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
900501174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Adventist Health Commercial |
$327.60
|
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$655.20
|
| Rate for Payer: EPIC Health Plan Senior |
$655.20
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,013.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.12
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
|
|
HC INJECTION FACIAL NERVE
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
900501174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$327.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,392.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$900.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,228.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Cigna of CA HMO |
$1,048.32
|
| Rate for Payer: Cigna of CA PPO |
$1,212.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,392.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,392.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,392.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$655.20
|
| Rate for Payer: EPIC Health Plan Senior |
$655.20
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,013.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,146.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,146.60
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$982.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$819.00
|
| Rate for Payer: United Healthcare All Other HMO |
$819.00
|
| Rate for Payer: United Healthcare HMO Rider |
$819.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$819.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,392.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,392.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,392.30
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$2,036.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$407.20 |
| Max. Negotiated Rate |
$1,730.60 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$814.40
|
| Rate for Payer: EPIC Health Plan Senior |
$814.40
|
| Rate for Payer: Galaxy Health WC |
$1,730.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,221.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$775.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,260.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.64
|
| Rate for Payer: Multiplan Commercial |
$1,628.80
|
| Rate for Payer: Networks By Design Commercial |
$1,323.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,730.60
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$2,036.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: Cigna of CA HMO |
$1,303.04
|
| Rate for Payer: Cigna of CA PPO |
$1,506.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,730.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,221.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,628.80
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,323.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,730.60
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,221.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,018.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,018.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,018.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,018.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
|
OP
|
$3,675.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.19 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$735.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,021.25
|
| Rate for Payer: Cash Price |
$2,021.25
|
| Rate for Payer: Cash Price |
$2,021.25
|
| Rate for Payer: Cigna of CA HMO |
$2,352.00
|
| Rate for Payer: Cigna of CA PPO |
$2,719.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$3,123.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,205.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,451.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$882.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$2,940.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,388.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,123.75
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
|
OP
|
$3,675.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.58 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$735.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,021.25
|
| Rate for Payer: Cash Price |
$2,021.25
|
| Rate for Payer: Cash Price |
$2,021.25
|
| Rate for Payer: Cigna of CA HMO |
$2,352.00
|
| Rate for Payer: Cigna of CA PPO |
$2,719.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$3,123.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,205.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,451.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$882.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$2,940.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,388.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,123.75
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,837.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,837.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,837.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,837.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
|
IP
|
$3,675.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$3,123.75 |
| Rate for Payer: Adventist Health Commercial |
$735.00
|
| Rate for Payer: Cash Price |
$2,021.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,470.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,470.00
|
| Rate for Payer: Galaxy Health WC |
$3,123.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,205.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,451.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,400.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,274.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$882.00
|
| Rate for Payer: Multiplan Commercial |
$2,940.00
|
| Rate for Payer: Networks By Design Commercial |
$2,388.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,123.75
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
|
IP
|
$3,675.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$3,123.75 |
| Rate for Payer: Adventist Health Commercial |
$735.00
|
| Rate for Payer: Cash Price |
$2,021.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,470.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,470.00
|
| Rate for Payer: Galaxy Health WC |
$3,123.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,205.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,451.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,400.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,274.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$882.00
|
| Rate for Payer: Multiplan Commercial |
$2,940.00
|
| Rate for Payer: Networks By Design Commercial |
$2,388.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,123.75
|
|
|
HC INJECTION SYNAGIS
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
908600140
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$148.31 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.83
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.50
|
| Rate for Payer: United Healthcare All Other HMO |
$36.50
|
| Rate for Payer: United Healthcare HMO Rider |
$36.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC INJECTION SYNAGIS
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
908600140
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$62.05 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.20
|
| Rate for Payer: EPIC Health Plan Senior |
$29.20
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
|
|
HC INJECTION TREATMENT OF EYE
|
Facility
|
IP
|
$5,570.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
900506030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,114.00 |
| Max. Negotiated Rate |
$4,734.50 |
| Rate for Payer: Adventist Health Commercial |
$1,114.00
|
| Rate for Payer: Cash Price |
$3,063.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,228.00
|
| Rate for Payer: Galaxy Health WC |
$4,734.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,715.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,122.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,447.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.80
|
| Rate for Payer: Multiplan Commercial |
$4,456.00
|
| Rate for Payer: Networks By Design Commercial |
$3,620.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,734.50
|
|
|
HC INJECTION TREATMENT OF EYE
|
Facility
|
OP
|
$5,570.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
900506030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,114.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,063.50
|
| Rate for Payer: Cash Price |
$3,063.50
|
| Rate for Payer: Cash Price |
$3,063.50
|
| Rate for Payer: Cigna of CA HMO |
$3,564.80
|
| Rate for Payer: Cigna of CA PPO |
$4,121.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$4,734.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,342.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,715.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$4,456.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$3,620.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,734.50
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,785.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,785.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,785.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC INJECTION TREATMENT OF NERVE
|
Facility
|
OP
|
$7,330.00
|
|
|
Service Code
|
CPT 64610
|
| Hospital Charge Code |
909000272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.64 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: Adventist Health Commercial |
$1,466.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$4,031.50
|
| Rate for Payer: Cash Price |
$4,031.50
|
| Rate for Payer: Cash Price |
$4,031.50
|
| Rate for Payer: Cigna of CA HMO |
$4,691.20
|
| Rate for Payer: Cigna of CA PPO |
$5,424.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$6,230.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,398.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$344.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,889.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,759.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$5,864.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$4,764.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,230.50
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,398.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC INJECTION TREATMENT OF NERVE
|
Facility
|
IP
|
$7,330.00
|
|
|
Service Code
|
CPT 64610
|
| Hospital Charge Code |
909000272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,466.00 |
| Max. Negotiated Rate |
$6,230.50 |
| Rate for Payer: Adventist Health Commercial |
$1,466.00
|
| Rate for Payer: Cash Price |
$4,031.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,932.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,932.00
|
| Rate for Payer: Galaxy Health WC |
$6,230.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,398.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,889.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,792.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,537.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,759.20
|
| Rate for Payer: Multiplan Commercial |
$5,864.00
|
| Rate for Payer: Networks By Design Commercial |
$4,764.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,230.50
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
IP
|
$1,669.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$333.80 |
| Max. Negotiated Rate |
$1,418.65 |
| Rate for Payer: Adventist Health Commercial |
$333.80
|
| Rate for Payer: Cash Price |
$917.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$667.60
|
| Rate for Payer: Galaxy Health WC |
$1,418.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,001.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,113.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$635.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,033.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.56
|
| Rate for Payer: Multiplan Commercial |
$1,335.20
|
| Rate for Payer: Networks By Design Commercial |
$1,084.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,418.65
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
OP
|
$1,669.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$333.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$917.95
|
| Rate for Payer: Cash Price |
$917.95
|
| Rate for Payer: Cash Price |
$917.95
|
| Rate for Payer: Cigna of CA HMO |
$1,068.16
|
| Rate for Payer: Cigna of CA PPO |
$1,235.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,418.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,001.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,113.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,335.20
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,084.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,418.65
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,001.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.50
|
| Rate for Payer: United Healthcare All Other HMO |
$834.50
|
| Rate for Payer: United Healthcare HMO Rider |
$834.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$834.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJECTION VITREOUS SUBSTITUTE
|
Facility
|
OP
|
$5,482.00
|
|
|
Service Code
|
CPT 67025
|
| Hospital Charge Code |
950510062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$961.32 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,096.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,015.10
|
| Rate for Payer: Cash Price |
$3,015.10
|
| Rate for Payer: Cash Price |
$3,015.10
|
| Rate for Payer: Cigna of CA HMO |
$3,508.48
|
| Rate for Payer: Cigna of CA PPO |
$4,056.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$4,659.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,289.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,656.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$961.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$4,385.60
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$3,563.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,659.70
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,741.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,741.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,741.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,741.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC INJECTION VITREOUS SUBSTITUTE
|
Facility
|
IP
|
$5,482.00
|
|
|
Service Code
|
CPT 67025
|
| Hospital Charge Code |
950510062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,096.40 |
| Max. Negotiated Rate |
$4,659.70 |
| Rate for Payer: Adventist Health Commercial |
$1,096.40
|
| Rate for Payer: Cash Price |
$3,015.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,192.80
|
| Rate for Payer: Galaxy Health WC |
$4,659.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,289.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,656.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,088.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,393.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.68
|
| Rate for Payer: Multiplan Commercial |
$4,385.60
|
| Rate for Payer: Networks By Design Commercial |
$3,563.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,659.70
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Cigna of CA HMO |
$254.72
|
| Rate for Payer: Cigna of CA PPO |
$294.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$338.30 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
|
