|
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: Cash Price |
$737.10
|
| Rate for Payer: Adventist Health Commercial |
$327.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,146.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,040.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$966.42
|
| 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 |
$2,601.00
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cash Price |
$737.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,146.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,040.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$594.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$966.42
|
| 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 |
$916.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,425.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,292.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,201.24
|
| 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
|
IP
|
$2,036.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$407.20 |
| Max. Negotiated Rate |
$1,730.60 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,425.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,292.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,201.24
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Cash Price |
$916.20
|
| 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 |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,425.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| 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/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,292.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$975.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,216.56
|
| 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 |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$2,036.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$834.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$437.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Cash Price |
$916.20
|
| 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 |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,425.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| 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/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,292.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$975.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,216.56
|
| 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: TriValley Medical Group Commercial/Senior |
$1,221.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
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 |
$1,653.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,572.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,333.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,168.25
|
| 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
|
OP
|
$3,675.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.19 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$735.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$1,653.75
|
| Rate for Payer: Cash Price |
$1,653.75
|
| Rate for Payer: Cash Price |
$1,653.75
|
| 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 |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,572.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| 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/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,333.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$305.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$882.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| 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 |
$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 |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
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 |
$1,653.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,572.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,333.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,168.25
|
| 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
|
OP
|
$3,675.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.58 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$735.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,653.75
|
| Rate for Payer: Cash Price |
$1,653.75
|
| Rate for Payer: Cash Price |
$1,653.75
|
| 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 |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,572.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| 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/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,333.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$305.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,222.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$882.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| 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 |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
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 |
$152.79 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.84
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| 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 |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.08
|
| 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 |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
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 |
$32.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$46.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.07
|
| 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 |
$2,506.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,899.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,536.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,286.30
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,114.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| 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 |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,899.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| 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/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,536.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,739.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,977.45
|
| 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 |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,466.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$3,298.50
|
| Rate for Payer: Cash Price |
$3,298.50
|
| Rate for Payer: Cash Price |
$3,298.50
|
| 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 |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,131.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$6,230.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,398.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$344.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,654.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,759.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,164.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,365.45
|
| 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 |
$3,665.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC 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 |
$3,298.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,131.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,654.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,324.70
|
| 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
|
OP
|
$1,669.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
| Rate for Payer: Adventist Health Commercial |
$333.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$751.05
|
| Rate for Payer: Cash Price |
$751.05
|
| Rate for Payer: Cash Price |
$751.05
|
| 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 |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| 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/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,059.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| 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 |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
OP
|
$1,669.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$684.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$421.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$751.05
|
| Rate for Payer: Cash Price |
$751.05
|
| Rate for Payer: Cash Price |
$751.05
|
| 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 |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| 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/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,059.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| 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: TriValley Medical Group Commercial/Senior |
$1,001.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
IP
|
$1,669.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$333.80 |
| Max. Negotiated Rate |
$1,418.65 |
| Rate for Payer: Adventist Health Commercial |
$333.80
|
| Rate for Payer: Cash Price |
$751.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,168.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,059.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$984.71
|
| 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
|
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 |
$751.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,168.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,059.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$984.71
|
| 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 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,096.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,466.90
|
| Rate for Payer: Cash Price |
$2,466.90
|
| Rate for Payer: Cash Price |
$2,466.90
|
| 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 |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,837.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| 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/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,481.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$961.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,739.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,977.45
|
| 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 |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
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 |
$2,466.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,837.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,481.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,234.38
|
| 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
|
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 |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| 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 |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$278.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.08
|
| 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 |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
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 |
$179.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$278.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$252.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.82
|
| 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
|
260
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| 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 |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$278.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.08
|
| 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 |
$111.12
|
| 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 |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
