|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
OP
|
$3,307.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$241.42 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$661.40
|
| Rate for Payer: Adventist Health Commercial |
$365.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,137.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,137.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| 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 Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,488.15
|
| Rate for Payer: Cash Price |
$1,488.15
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$1,488.15
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,461.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,645.60
|
| Rate for Payer: Cigna of CA HMO |
$1,169.28
|
| Rate for Payer: Cigna of CA HMO |
$2,116.48
|
| Rate for Payer: Cigna of CA PPO |
$2,447.18
|
| Rate for Payer: Cigna of CA PPO |
$1,351.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| 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 Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,278.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,314.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$2,810.95
|
| Rate for Payer: Galaxy Health WC |
$1,552.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,096.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,984.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,644.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,976.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$241.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$241.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,160.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,099.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$661.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,480.25
|
| Rate for Payer: Multiplan Commercial |
$1,370.25
|
| Rate for Payer: Networks By Design Commercial |
$2,149.55
|
| Rate for Payer: Networks By Design Commercial |
$1,187.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Prime Health Services Commercial |
$1,552.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,810.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,096.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,984.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,365.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,365.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,653.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$913.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| 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 HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| 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 Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
IP
|
$3,307.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$661.40 |
| Max. Negotiated Rate |
$2,976.30 |
| Rate for Payer: Adventist Health Commercial |
$661.40
|
| Rate for Payer: Cash Price |
$1,488.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,645.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,314.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,322.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,322.80
|
| Rate for Payer: Galaxy Health WC |
$2,810.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,984.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,976.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,099.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,951.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$661.40
|
| Rate for Payer: Multiplan Commercial |
$2,480.25
|
| Rate for Payer: Networks By Design Commercial |
$2,149.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,810.95
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
OP
|
$3,307.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.42 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$661.40
|
| Rate for Payer: Adventist Health Commercial |
$365.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,137.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,137.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| 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 Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$1,488.15
|
| Rate for Payer: Cash Price |
$1,488.15
|
| Rate for Payer: Cash Price |
$1,488.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,645.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,461.60
|
| Rate for Payer: Cigna of CA HMO |
$1,169.28
|
| Rate for Payer: Cigna of CA HMO |
$2,116.48
|
| Rate for Payer: Cigna of CA PPO |
$2,447.18
|
| Rate for Payer: Cigna of CA PPO |
$1,351.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| 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 Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,278.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,314.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$2,810.95
|
| Rate for Payer: Galaxy Health WC |
$1,552.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,984.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,096.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,644.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,976.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$241.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$241.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,099.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,160.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$661.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,480.25
|
| Rate for Payer: Multiplan Commercial |
$1,370.25
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,187.55
|
| Rate for Payer: Networks By Design Commercial |
$2,149.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,810.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,552.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,984.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,096.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$913.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,653.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| 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 HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| 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 Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
IP
|
$3,307.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$661.40 |
| Max. Negotiated Rate |
$2,976.30 |
| Rate for Payer: Adventist Health Commercial |
$661.40
|
| Rate for Payer: Cash Price |
$1,488.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,645.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,314.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,322.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,322.80
|
| Rate for Payer: Galaxy Health WC |
$2,810.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,984.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,976.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,099.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,951.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$661.40
|
| Rate for Payer: Multiplan Commercial |
$2,480.25
|
| Rate for Payer: Networks By Design Commercial |
$2,149.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,810.95
|
|
|
HC INJECT/ASPIRATE LIVER CYST
|
Facility
|
IP
|
$8,021.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
909081848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,604.20 |
| Max. Negotiated Rate |
$7,218.90 |
| Rate for Payer: Adventist Health Commercial |
$1,604.20
|
| Rate for Payer: Cash Price |
$3,609.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,416.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,614.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,208.40
|
| Rate for Payer: Galaxy Health WC |
$6,817.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,812.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,218.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,093.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,732.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,604.20
|
| Rate for Payer: Multiplan Commercial |
$6,015.75
|
| Rate for Payer: Networks By Design Commercial |
$5,213.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,817.85
|
|
|
HC INJECT/ASPIRATE LIVER CYST
|
Facility
|
OP
|
$8,021.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
909081848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$864.49 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,604.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,817.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,411.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,015.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,609.45
|
| Rate for Payer: Cash Price |
$3,609.45
|
| Rate for Payer: Cash Price |
$3,609.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,416.80
|
| Rate for Payer: Cigna of CA HMO |
$5,133.44
|
| Rate for Payer: Cigna of CA PPO |
$5,935.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,817.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,817.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,817.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,614.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,208.40
|
| Rate for Payer: Galaxy Health WC |
$6,817.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,812.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,218.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$864.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,093.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$954.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,732.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,604.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,614.70
|
| Rate for Payer: Multiplan Commercial |
$6,015.75
|
| Rate for Payer: Networks By Design Commercial |
$5,213.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,817.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,208.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,812.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,010.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,817.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,817.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,817.85
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$534.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$534.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$488.96
|
| Rate for Payer: Cigna of CA PPO |
$565.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$534.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$382.00
|
| Rate for Payer: United Healthcare All Other HMO |
$382.00
|
| Rate for Payer: United Healthcare HMO Rider |
$382.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$382.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$313.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$488.96
|
| Rate for Payer: Cigna of CA PPO |
$565.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$534.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$458.40
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.50 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$488.96
|
| Rate for Payer: Cigna of CA PPO |
$565.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$534.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$382.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$534.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
|
|
HC INJECTION ADMIN SYNAGIS
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
912190471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC INJECTION ADMIN SYNAGIS
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
912190471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$152.79 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.36
|
| 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 Exchange |
$42.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.19
|
| Rate for Payer: Blue Shield of California Commercial |
$55.79
|
| Rate for Payer: Blue Shield of California EPN |
$35.11
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| 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 |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| 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 |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Prime Health Services Medicare |
$98.16
|
| Rate for Payer: Riverside University Health System MISP |
$101.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.00
|
| Rate for Payer: United Healthcare All Other HMO |
$44.00
|
| Rate for Payer: United Healthcare HMO Rider |
$44.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.00
|
| 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 INJECTION EYE DRUG
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
900501532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$671.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: Cigna of CA HMO |
$1,324.80
|
| Rate for Payer: Cigna of CA PPO |
$1,531.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,314.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$691.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Preferred Health Network WC |
$685.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,035.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,035.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC INJECTION EYE DRUG
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
900501532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,314.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
|
|
HC INJECTION FACIAL NERVE
|
Facility
|
IP
|
$2,548.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
900501174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$2,293.20 |
| Rate for Payer: Adventist Health Commercial |
$509.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,038.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,783.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,019.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,019.20
|
| Rate for Payer: Galaxy Health WC |
$2,165.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,293.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,617.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,503.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.60
|
| Rate for Payer: Multiplan Commercial |
$1,911.00
|
| Rate for Payer: Networks By Design Commercial |
$1,656.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,165.80
|
|
|
HC INJECTION FACIAL NERVE
|
Facility
|
OP
|
$2,548.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
900501174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$509.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,165.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,401.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,911.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,038.40
|
| Rate for Payer: Cigna of CA HMO |
$1,630.72
|
| Rate for Payer: Cigna of CA PPO |
$1,885.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,165.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,165.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,165.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,783.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,019.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,019.20
|
| Rate for Payer: Galaxy Health WC |
$2,165.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,293.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,617.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$924.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,503.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,783.60
|
| Rate for Payer: Multiplan Commercial |
$1,911.00
|
| Rate for Payer: Networks By Design Commercial |
$1,656.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,165.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,019.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,274.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,274.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,274.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,274.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,165.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,165.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,165.80
|
|
|
HC INJECTION FACIAL NERVE
|
Facility
|
IP
|
$2,548.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
900501174
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$2,293.20 |
| Rate for Payer: Adventist Health Commercial |
$509.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,038.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,783.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,019.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,019.20
|
| Rate for Payer: Galaxy Health WC |
$2,165.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,293.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,617.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,503.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.60
|
| Rate for Payer: Multiplan Commercial |
$1,911.00
|
| Rate for Payer: Networks By Design Commercial |
$1,656.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,165.80
|
|
|
HC INJECTION FACIAL NERVE
|
Facility
|
OP
|
$2,548.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
900501174
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$2,685.00 |
| Rate for Payer: Adventist Health Commercial |
$509.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,547.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,165.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,401.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,911.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,615.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,016.65
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,038.40
|
| Rate for Payer: Cigna of CA HMO |
$1,630.72
|
| Rate for Payer: Cigna of CA PPO |
$1,885.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,165.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,165.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,165.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,783.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,019.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,019.20
|
| Rate for Payer: Galaxy Health WC |
$2,165.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,293.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,617.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$924.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,503.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,783.60
|
| Rate for Payer: Multiplan Commercial |
$1,911.00
|
| Rate for Payer: Networks By Design Commercial |
$1,656.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,165.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,019.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,528.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,274.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,274.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,274.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,274.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,165.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,165.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,165.80
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$3,167.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$633.40 |
| Max. Negotiated Rate |
$2,850.30 |
| Rate for Payer: Adventist Health Commercial |
$633.40
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,533.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,216.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,266.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,266.80
|
| Rate for Payer: Galaxy Health WC |
$2,691.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,850.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,011.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,868.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.40
|
| Rate for Payer: Multiplan Commercial |
$2,375.25
|
| Rate for Payer: Networks By Design Commercial |
$2,058.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,691.95
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$3,167.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$633.40 |
| Max. Negotiated Rate |
$2,850.30 |
| Rate for Payer: Adventist Health Commercial |
$633.40
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,533.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,216.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,266.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,266.80
|
| Rate for Payer: Galaxy Health WC |
$2,691.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,850.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,011.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,868.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.40
|
| Rate for Payer: Multiplan Commercial |
$2,375.25
|
| Rate for Payer: Networks By Design Commercial |
$2,058.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,691.95
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$3,167.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,298.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$386.24
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,533.60
|
| Rate for Payer: Cigna of CA HMO |
$2,026.88
|
| Rate for Payer: Cigna of CA PPO |
$2,343.58
|
| 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 |
$2,216.90
|
| 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 |
$2,691.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,850.30
|
| 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 |
$2,011.05
|
| 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 |
$633.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,375.25
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,058.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$907.88
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$2,691.95
|
| Rate for Payer: Prime Health Services Medicare |
$962.35
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$998.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,900.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,900.20
|
| 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 OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$3,167.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$633.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,533.60
|
| Rate for Payer: Cigna of CA HMO |
$2,026.88
|
| Rate for Payer: Cigna of CA PPO |
$2,343.58
|
| 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 |
$2,216.90
|
| 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 |
$2,691.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,850.30
|
| 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 |
$2,011.05
|
| 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 |
$633.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,375.25
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,058.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$907.88
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$2,691.95
|
| Rate for Payer: Prime Health Services Medicare |
$962.35
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$998.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,900.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,583.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,583.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,583.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,583.50
|
| 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
|
$4,973.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$994.60 |
| Max. Negotiated Rate |
$4,475.70 |
| Rate for Payer: Adventist Health Commercial |
$994.60
|
| Rate for Payer: Cash Price |
$2,237.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,978.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,481.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,989.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,989.20
|
| Rate for Payer: Galaxy Health WC |
$4,227.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,983.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,475.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,157.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,934.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.60
|
| Rate for Payer: Multiplan Commercial |
$3,729.75
|
| Rate for Payer: Networks By Design Commercial |
$3,232.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,227.05
|
|
