|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
|
OP
|
$4,973.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$276.63 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$994.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,137.58
|
| 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 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 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 |
$1,802.37
|
| 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 |
$2,237.85
|
| Rate for Payer: Cash Price |
$2,237.85
|
| Rate for Payer: Cash Price |
$2,237.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,978.40
|
| Rate for Payer: Cigna of CA HMO |
$3,182.72
|
| Rate for Payer: Cigna of CA PPO |
$3,680.02
|
| 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 |
$3,481.10
|
| 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 |
$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: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$276.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,157.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$305.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$3,729.75
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$3,232.45
|
| 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: Prime Health Services Commercial |
$4,227.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,983.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,486.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
|
IP
|
$4,973.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
361
|
| 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
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
|
OP
|
$4,973.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.58 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$994.60
|
| 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 |
$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 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 |
$1,802.37
|
| Rate for Payer: Cash Price |
$2,237.85
|
| Rate for Payer: Cash Price |
$2,237.85
|
| Rate for Payer: Cash Price |
$2,237.85
|
| Rate for Payer: Cash Price |
$2,237.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,978.40
|
| Rate for Payer: Cigna of CA HMO |
$3,182.72
|
| Rate for Payer: Cigna of CA PPO |
$3,680.02
|
| 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 |
$3,481.10
|
| 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 |
$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: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,157.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$305.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,222.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$3,729.75
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$3,232.45
|
| 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: Prime Health Services Commercial |
$4,227.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,983.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,486.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,486.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,486.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,486.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC INJECTION TREATMENT OF EYE
|
Facility
|
OP
|
$8,789.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
900506030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$7,910.10 |
| Rate for Payer: Adventist Health Commercial |
$1,757.80
|
| 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 |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$4,617.28
|
| Rate for Payer: Cash Price |
$3,955.05
|
| Rate for Payer: Cash Price |
$3,955.05
|
| Rate for Payer: Cash Price |
$3,955.05
|
| Rate for Payer: Cash Price |
$3,955.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,031.20
|
| Rate for Payer: Cigna of CA HMO |
$5,624.96
|
| Rate for Payer: Cigna of CA PPO |
$6,503.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,152.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$7,470.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,273.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,910.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,581.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,757.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$6,591.75
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$5,712.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$7,470.65
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,273.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,394.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,394.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,394.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,394.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC INJECTION TREATMENT OF EYE
|
Facility
|
IP
|
$8,789.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
900506030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,757.80 |
| Max. Negotiated Rate |
$7,910.10 |
| Rate for Payer: Adventist Health Commercial |
$1,757.80
|
| Rate for Payer: Cash Price |
$3,955.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,031.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,152.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,515.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,515.60
|
| Rate for Payer: Galaxy Health WC |
$7,470.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,273.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,910.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,581.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,185.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,757.80
|
| Rate for Payer: Multiplan Commercial |
$6,591.75
|
| Rate for Payer: Networks By Design Commercial |
$5,712.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,470.65
|
|
|
HC INJECTION TREATMENT OF NERVE
|
Facility
|
OP
|
$9,918.00
|
|
|
Service Code
|
CPT 64610
|
| Hospital Charge Code |
909000272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$352.84 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,983.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,511.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$3,953.34
|
| 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 |
$4,463.10
|
| Rate for Payer: Cash Price |
$4,463.10
|
| Rate for Payer: Cash Price |
$4,463.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,934.40
|
| Rate for Payer: Cigna of CA HMO |
$6,347.52
|
| Rate for Payer: Cigna of CA PPO |
$7,339.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,942.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$8,430.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,950.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,926.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$352.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,297.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,983.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$7,438.50
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$6,446.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Commercial |
$8,430.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,662.22
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,762.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,950.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,959.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC INJECTION TREATMENT OF NERVE
|
Facility
|
IP
|
$9,918.00
|
|
|
Service Code
|
CPT 64610
|
| Hospital Charge Code |
909000272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,983.60 |
| Max. Negotiated Rate |
$8,926.20 |
| Rate for Payer: Adventist Health Commercial |
$1,983.60
|
| Rate for Payer: Cash Price |
$4,463.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,934.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,942.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,967.20
|
| Rate for Payer: Galaxy Health WC |
$8,430.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,950.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,926.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,297.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,851.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,983.60
|
| Rate for Payer: Multiplan Commercial |
$7,438.50
|
| Rate for Payer: Networks By Design Commercial |
$6,446.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,430.30
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
IP
|
$1,623.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,460.70 |
| Rate for Payer: Adventist Health Commercial |
$324.60
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,298.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,136.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$649.20
|
| Rate for Payer: EPIC Health Plan Senior |
$649.20
|
| Rate for Payer: Galaxy Health WC |
$1,379.55
|
| Rate for Payer: Global Benefits Group Commercial |
$973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,460.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,030.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$957.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.60
|
| Rate for Payer: Multiplan Commercial |
$1,217.25
|
| Rate for Payer: Networks By Design Commercial |
$1,054.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,379.55
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
OP
|
$1,623.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$324.60
|
| 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 |
$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 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 |
$597.61
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,298.40
|
| Rate for Payer: Cigna of CA HMO |
$1,038.72
|
| Rate for Payer: Cigna of CA PPO |
$1,201.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,136.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,379.55
|
| Rate for Payer: Global Benefits Group Commercial |
$973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,460.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,030.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,217.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,054.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,379.55
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$973.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.50
|
| Rate for Payer: United Healthcare All Other HMO |
$811.50
|
| Rate for Payer: United Healthcare HMO Rider |
$811.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$811.50
|
| 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 INJECTION TRIGEMINAL NERVE
|
Facility
|
IP
|
$1,623.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,460.70 |
| Rate for Payer: Adventist Health Commercial |
$324.60
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,298.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,136.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$649.20
|
| Rate for Payer: EPIC Health Plan Senior |
$649.20
|
| Rate for Payer: Galaxy Health WC |
$1,379.55
|
| Rate for Payer: Global Benefits Group Commercial |
$973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,460.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,030.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$957.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.60
|
| Rate for Payer: Multiplan Commercial |
$1,217.25
|
| Rate for Payer: Networks By Design Commercial |
$1,054.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,379.55
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
OP
|
$1,623.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$665.43
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$372.25
|
| 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 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 |
$597.61
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,298.40
|
| Rate for Payer: Cigna of CA HMO |
$1,038.72
|
| Rate for Payer: Cigna of CA PPO |
$1,201.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,136.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,379.55
|
| Rate for Payer: Global Benefits Group Commercial |
$973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,460.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,030.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,217.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,054.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,379.55
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$973.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$973.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJECTION VITREOUS SUBSTITUTE
|
Facility
|
OP
|
$8,217.00
|
|
|
Service Code
|
CPT 67025
|
| Hospital Charge Code |
950510062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,395.30 |
| Rate for Payer: Adventist Health Commercial |
$1,643.40
|
| 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 |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$4,617.28
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,573.60
|
| Rate for Payer: Cigna of CA HMO |
$5,258.88
|
| Rate for Payer: Cigna of CA PPO |
$6,080.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,751.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,395.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,217.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$961.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$5,341.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,930.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,108.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,108.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,108.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,108.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC INJECTION VITREOUS SUBSTITUTE
|
Facility
|
IP
|
$8,217.00
|
|
|
Service Code
|
CPT 67025
|
| Hospital Charge Code |
950510062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,643.40 |
| Max. Negotiated Rate |
$7,395.30 |
| Rate for Payer: Adventist Health Commercial |
$1,643.40
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,573.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,751.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,395.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,217.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.40
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Networks By Design Commercial |
$5,341.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
|
|
HC INJECT SINUS TRACT; THERAPEUTIC
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
909020500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$800.40 |
| Max. Negotiated Rate |
$3,601.80 |
| Rate for Payer: Adventist Health Commercial |
$800.40
|
| Rate for Payer: Cash Price |
$1,800.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,201.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,801.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,600.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,600.80
|
| Rate for Payer: Galaxy Health WC |
$3,401.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,401.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,601.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,541.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,361.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.40
|
| Rate for Payer: Multiplan Commercial |
$3,001.50
|
| Rate for Payer: Networks By Design Commercial |
$2,601.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,401.70
|
|
|
HC INJECT SINUS TRACT; THERAPEUTIC
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
909020500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.86 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$800.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,995.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$510.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| 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: Blue Shield of California Commercial |
$2,521.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,588.79
|
| Rate for Payer: Cash Price |
$1,800.90
|
| Rate for Payer: Cash Price |
$1,800.90
|
| Rate for Payer: Cash Price |
$1,800.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,201.60
|
| Rate for Payer: Cigna of CA HMO |
$2,561.28
|
| Rate for Payer: Cigna of CA PPO |
$2,961.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,801.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Galaxy Health WC |
$3,401.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,401.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,601.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$181.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,541.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,793.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$3,001.50
|
| Rate for Payer: Networks By Design Commercial |
$2,601.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,401.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,115.34
|
| Rate for Payer: Riverside University Health System MISP |
$2,195.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,401.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,401.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,001.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,001.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,001.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,001.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.00
|
| 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 Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Blue Shield of California Commercial |
$300.52
|
| Rate for Payer: Blue Shield of California EPN |
$189.13
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Cigna of CA HMO |
$303.36
|
| Rate for Payer: Cigna of CA PPO |
$350.76
|
| 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 |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.99
|
| 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 |
$94.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| 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 |
$284.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| 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
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$279.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$144.09
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Cigna of CA HMO |
$303.36
|
| Rate for Payer: Cigna of CA PPO |
$350.76
|
| 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 |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.99
|
| 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 |
$94.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Multiplan WC |
$144.09
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Preferred Health Network WC |
$147.03
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| Rate for Payer: Prime Health Services Medicare |
$98.16
|
| Rate for Payer: Prime Health Services WC |
$142.62
|
| Rate for Payer: Riverside University Health System MISP |
$101.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.00
|
| Rate for Payer: United Healthcare All Other HMO |
$237.00
|
| Rate for Payer: United Healthcare HMO Rider |
$237.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.00
|
| 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
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| 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 |
$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 |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$144.09
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Cigna of CA HMO |
$303.36
|
| Rate for Payer: Cigna of CA PPO |
$350.76
|
| 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 |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| 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 |
$300.99
|
| 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 |
$94.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Multiplan WC |
$144.09
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Preferred Health Network WC |
$147.03
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| Rate for Payer: Prime Health Services Medicare |
$98.16
|
| Rate for Payer: Prime Health Services WC |
$142.62
|
| Rate for Payer: Riverside University Health System MISP |
$101.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.00
|
| Rate for Payer: United Healthcare All Other HMO |
$237.00
|
| Rate for Payer: United Healthcare HMO Rider |
$237.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.00
|
| 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
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$279.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$279.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.00
|
| 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 Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Cigna of CA HMO |
$303.36
|
| Rate for Payer: Cigna of CA PPO |
$350.76
|
| 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 |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.99
|
| 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 |
$94.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| 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 |
$284.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$279.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.00
|
| 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 Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Blue Shield of California Commercial |
$300.52
|
| Rate for Payer: Blue Shield of California EPN |
$189.13
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Cigna of CA HMO |
$303.36
|
| Rate for Payer: Cigna of CA PPO |
$350.76
|
| 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 |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.99
|
| 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 |
$94.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| 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 |
$284.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.00
|
| Rate for Payer: United Healthcare All Other HMO |
$237.00
|
| Rate for Payer: United Healthcare HMO Rider |
$237.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.00
|
| 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
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$279.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
|
