|
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 |
$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 |
$2,601.00
|
| 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 |
$973.00
|
| 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 |
$99.55
|
| 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
|
260
|
| 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
|
IP
|
$398.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
510
|
| 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
|
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 |
$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
|
510
|
| 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 |
$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 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 |
$641.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$997.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$904.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$840.75
|
| 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
|
510
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$997.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$904.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$840.75
|
| 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
|
450
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| 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 |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| 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 |
$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 |
$997.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| 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 |
$904.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| 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 |
$1,140.00
|
| 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 |
$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 INJECT TRIGGER POINT 1 OR 2
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$584.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$233.59
|
| 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 |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| 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 |
$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 |
$997.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| 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 |
$904.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| 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 |
$1,140.00
|
| 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: TriValley Medical Group Commercial/Senior |
$855.00
|
| 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 INJECT TRIGGER POINT 1 OR 2
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$997.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$904.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$840.75
|
| 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
|
510
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$233.59
|
| 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 |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| 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 |
$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 |
$997.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$904.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| 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 |
$1,140.00
|
| Rate for Payer: Networks By Design Commercial |
$926.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,211.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$855.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$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 |
$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 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 |
$641.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$997.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$904.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$840.75
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| 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 |
$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 |
$997.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$904.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| 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 |
$1,140.00
|
| 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 |
$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 |
$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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$216.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$487.35
|
| Rate for Payer: Cash Price |
$487.35
|
| Rate for Payer: Cash Price |
$487.35
|
| 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 |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$758.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$920.55
|
| Rate for Payer: Global Benefits Group Commercial |
$649.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$687.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$344.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.58
|
| 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 |
$541.50
|
| 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 |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
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 |
$487.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$758.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$687.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$638.97
|
| 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 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 |
$1,323.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,734.60
|
| 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
|
OP
|
$2,940.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
909081858
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$223.91 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$253.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,734.60
|
| 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 |
$1,470.00
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,734.60
|
| 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 |
$1,470.00
|
| 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 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 |
$1,323.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,734.60
|
| 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
|
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 |
$1,323.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,734.60
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| 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 |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| 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 |
$1,706.37
|
| 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 |
$2,058.00
|
| 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 |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| 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 |
$2,352.00
|
| 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 |
$1,470.00
|
| 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 |
$1,137.58
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| 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 |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| 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 |
$1,706.37
|
| 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 |
$2,058.00
|
| 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 |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$240.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$272.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| 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 |
$2,352.00
|
| 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 |
$1,470.00
|
| 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 |
$1,137.58
|
| 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 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 |
$1,323.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,734.60
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$647.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$1,455.75
|
| Rate for Payer: Cash Price |
$1,455.75
|
| Rate for Payer: Cash Price |
$1,455.75
|
| 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 |
$1,361.82
|
| 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 |
$2,264.50
|
| 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 |
$2,749.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,941.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$375.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,054.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.40
|
| 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 |
$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 |
$1,617.50
|
| 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 |
$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 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 |
$1,455.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,264.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,054.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,908.65
|
| 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
|
|
