|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$2,489.00
|
| 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 |
$973.00
|
| 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: Multiplan WC |
$144.09
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Prime Health Services WC |
$142.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$199.00
|
| Rate for Payer: United Healthcare All Other HMO |
$199.00
|
| Rate for Payer: United Healthcare HMO Rider |
$199.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.00
|
| 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
|
450
|
| 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
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| 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: Multiplan WC |
$144.09
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Prime Health Services WC |
$142.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$199.00
|
| Rate for Payer: United Healthcare All Other HMO |
$199.00
|
| Rate for Payer: United Healthcare HMO Rider |
$199.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.00
|
| 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
|
260
|
| 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
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$570.00
|
| Rate for Payer: EPIC Health Plan Senior |
$570.00
|
| Rate for Payer: Galaxy Health WC |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$950.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$882.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: Networks By Design Commercial |
$926.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,211.25
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$570.00
|
| Rate for Payer: EPIC Health Plan Senior |
$570.00
|
| Rate for Payer: Galaxy Health WC |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$950.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$882.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: Networks By Design Commercial |
$926.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,211.25
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| 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: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cigna of CA HMO |
$912.00
|
| Rate for Payer: Cigna of CA PPO |
$1,054.50
|
| 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 |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$950.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| 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 |
$1,140.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$926.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,211.25
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$855.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| 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 |
$783.75
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cigna of CA HMO |
$912.00
|
| Rate for Payer: Cigna of CA PPO |
$1,054.50
|
| 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 |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| 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 |
$950.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| 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 |
$1,140.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$926.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,211.25
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$855.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$712.50
|
| Rate for Payer: United Healthcare All Other HMO |
$712.50
|
| Rate for Payer: United Healthcare HMO Rider |
$712.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$712.50
|
| 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 INJECT W/FLUOR, EVAL CV DEVICE
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
909081842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.60 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Adventist Health Commercial |
$216.60
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$433.20
|
| Rate for Payer: EPIC Health Plan Senior |
$433.20
|
| Rate for Payer: Galaxy Health WC |
$920.55
|
| Rate for Payer: Global Benefits Group Commercial |
$649.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$722.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$412.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$670.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.92
|
| Rate for Payer: Multiplan Commercial |
$866.40
|
| Rate for Payer: Networks By Design Commercial |
$703.95
|
| Rate for Payer: Prime Health Services Commercial |
$920.55
|
|
|
HC INJECT W/FLUOR, EVAL CV DEVICE
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
909081842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.76 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$216.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| 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 |
$570.02
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cigna of CA HMO |
$693.12
|
| Rate for Payer: Cigna of CA PPO |
$801.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$920.55
|
| Rate for Payer: Global Benefits Group Commercial |
$649.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$722.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$866.40
|
| Rate for Payer: Multiplan WC |
$426.54
|
| Rate for Payer: Networks By Design Commercial |
$703.95
|
| Rate for Payer: Prime Health Services Commercial |
$920.55
|
| Rate for Payer: Prime Health Services WC |
$422.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$649.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
OP
|
$2,940.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
909081858
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$223.91 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,617.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,205.00
|
| 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 |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna of CA HMO |
$1,881.60
|
| Rate for Payer: Cigna of CA PPO |
$2,175.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,499.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,499.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$223.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,819.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,058.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,058.00
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,911.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,764.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,499.00
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
OP
|
$2,940.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
909081856
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$235.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,617.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,205.00
|
| 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 |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna of CA HMO |
$1,881.60
|
| Rate for Payer: Cigna of CA PPO |
$2,175.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,499.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,499.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$235.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,819.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,058.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,058.00
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,911.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,764.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,499.00
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
IP
|
$2,940.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
909081858
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,120.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,819.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,911.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
IP
|
$2,940.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
909081856
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,120.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,819.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,911.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
|
|
HC INJ FORAMEN EPIDURAL C/T
|
Facility
|
OP
|
$2,940.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
909081855
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$259.56 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| 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 |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna of CA HMO |
$1,881.60
|
| Rate for Payer: Cigna of CA PPO |
$2,175.60
|
| 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 |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| 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 |
$2,352.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,911.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,764.00
|
| 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 INJ FORAMEN EPIDURAL C/T
|
Facility
|
IP
|
$2,940.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
909081855
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,120.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,819.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,911.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
|
|
HC INJ FORAMEN EPIDURAL L/S
|
Facility
|
OP
|
$2,940.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
909081857
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.81 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| 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 |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna of CA HMO |
$1,881.60
|
| Rate for Payer: Cigna of CA PPO |
$2,175.60
|
| 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 |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$240.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| 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 |
$2,352.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,911.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,764.00
|
| 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 INJ FORAMEN EPIDURAL L/S
|
Facility
|
IP
|
$2,940.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
909081857
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,120.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,819.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,911.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
|
|
HC INJ INTER CRV/THRC WGUID
|
Facility
|
OP
|
$3,235.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
907262321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$375.28 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Galaxy Health WC |
$2,749.75
|
| Rate for Payer: Adventist Health Commercial |
$647.00
|
| 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: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,779.25
|
| Rate for Payer: Cash Price |
$1,779.25
|
| Rate for Payer: Cash Price |
$1,779.25
|
| Rate for Payer: Cigna of CA HMO |
$2,070.40
|
| Rate for Payer: Cigna of CA PPO |
$2,393.90
|
| 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: Global Benefits Group Commercial |
$1,941.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$375.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,157.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.40
|
| 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 |
$2,588.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,102.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,749.75
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,941.00
|
| 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 |
$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 INJ INTER CRV/THRC WGUID
|
Facility
|
IP
|
$3,235.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
907262321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$647.00 |
| Max. Negotiated Rate |
$2,749.75 |
| Rate for Payer: Adventist Health Commercial |
$647.00
|
| Rate for Payer: Cash Price |
$1,779.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,294.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,294.00
|
| Rate for Payer: Galaxy Health WC |
$2,749.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,941.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,157.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,232.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,002.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.40
|
| Rate for Payer: Multiplan Commercial |
$2,588.00
|
| Rate for Payer: Networks By Design Commercial |
$2,102.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,749.75
|
|
|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
IP
|
$2,940.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,120.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,819.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,911.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
|
|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
OP
|
$2,940.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| 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: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna of CA HMO |
$1,881.60
|
| Rate for Payer: Cigna of CA PPO |
$2,175.60
|
| 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 |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| 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 |
$2,352.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,911.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,764.00
|
| 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 |
$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 INJ INTER LMBR/SAC W GUID
|
Facility
|
IP
|
$3,689.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$737.80 |
| Max. Negotiated Rate |
$3,135.65 |
| Rate for Payer: Adventist Health Commercial |
$737.80
|
| Rate for Payer: Cash Price |
$2,028.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,475.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,475.60
|
| Rate for Payer: Galaxy Health WC |
$3,135.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,213.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,460.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,405.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,283.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$885.36
|
| Rate for Payer: Multiplan Commercial |
$2,951.20
|
| Rate for Payer: Networks By Design Commercial |
$2,397.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,135.65
|
|
|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
OP
|
$3,689.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$369.65 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$737.80
|
| 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: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,028.95
|
| Rate for Payer: Cash Price |
$2,028.95
|
| Rate for Payer: Cash Price |
$2,028.95
|
| Rate for Payer: Cigna of CA HMO |
$2,360.96
|
| Rate for Payer: Cigna of CA PPO |
$2,729.86
|
| 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 |
$3,135.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,213.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$369.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,460.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$885.36
|
| 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 |
$2,951.20
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,397.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,135.65
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,213.40
|
| 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 |
$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 INJ INTER LMBR/SAC WO GUID
|
Facility
|
IP
|
$2,940.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,120.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,819.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,911.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
|
