|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
750
|
| 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
|
720
|
| 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
|
750
|
| 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: 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: 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 |
$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
|
771
|
| 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 TRIGGER POINT 1 OR 2
|
Facility
|
OP
|
$1,930.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| 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 |
$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 |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: Cigna of CA HMO |
$1,235.20
|
| Rate for Payer: Cigna of CA PPO |
$1,428.20
|
| 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 |
$1,351.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,225.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| 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 |
$1,640.50
|
| 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 |
$1,158.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.00
|
| Rate for Payer: United Healthcare All Other HMO |
$965.00
|
| Rate for Payer: United Healthcare HMO Rider |
$965.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
OP
|
$1,930.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.28 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$394.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 |
$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 |
$597.61
|
| 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 |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: Cigna of CA HMO |
$1,235.20
|
| Rate for Payer: Cigna of CA PPO |
$1,428.20
|
| 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 |
$1,351.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,225.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| 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 |
$1,640.50
|
| 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 |
$1,158.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.00
|
| 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 |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
IP
|
$1,930.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,351.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.00
|
| Rate for Payer: EPIC Health Plan Senior |
$772.00
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,225.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,138.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
OP
|
$1,930.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$791.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$206.16
|
| 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 |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: Cigna of CA HMO |
$1,235.20
|
| Rate for Payer: Cigna of CA PPO |
$1,428.20
|
| 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 |
$1,351.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,225.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| 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 |
$1,640.50
|
| 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 |
$1,158.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,158.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
IP
|
$1,930.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,351.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.00
|
| Rate for Payer: EPIC Health Plan Senior |
$772.00
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,225.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,138.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
IP
|
$1,930.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,351.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.00
|
| Rate for Payer: EPIC Health Plan Senior |
$772.00
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,225.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,138.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
|
|
HC INJECT W/FLUOR, EVAL CV DEVICE
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
909081842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$190.18 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$249.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$273.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$426.54
|
| 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 |
$560.25
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Central Health Plan Commercial |
$996.00
|
| Rate for Payer: Cigna of CA HMO |
$796.80
|
| Rate for Payer: Cigna of CA PPO |
$921.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$871.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$1,058.25
|
| Rate for Payer: Global Benefits Group Commercial |
$747.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,120.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$190.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$790.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$933.75
|
| Rate for Payer: Multiplan WC |
$426.54
|
| Rate for Payer: Networks By Design Commercial |
$809.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$273.57
|
| Rate for Payer: Preferred Health Network WC |
$435.24
|
| Rate for Payer: Prime Health Services Commercial |
$1,058.25
|
| Rate for Payer: Prime Health Services Medicare |
$289.98
|
| Rate for Payer: Prime Health Services WC |
$422.18
|
| Rate for Payer: Riverside University Health System MISP |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$747.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$622.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC INJECT W/FLUOR, EVAL CV DEVICE
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
909081842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.00 |
| Max. Negotiated Rate |
$1,120.50 |
| Rate for Payer: Adventist Health Commercial |
$249.00
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Central Health Plan Commercial |
$996.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$871.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$498.00
|
| Rate for Payer: Galaxy Health WC |
$1,058.25
|
| Rate for Payer: Global Benefits Group Commercial |
$747.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,120.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$790.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$734.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$933.75
|
| Rate for Payer: Networks By Design Commercial |
$809.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,058.25
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
IP
|
$2,858.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
909081858
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$571.60 |
| Max. Negotiated Rate |
$2,572.20 |
| Rate for Payer: Adventist Health Commercial |
$571.60
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,286.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,000.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,143.20
|
| Rate for Payer: Galaxy Health WC |
$2,429.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,572.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,814.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,686.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.60
|
| Rate for Payer: Multiplan Commercial |
$2,143.50
|
| Rate for Payer: Networks By Design Commercial |
$1,857.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,429.30
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
IP
|
$3,978.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
909081856
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.60 |
| Max. Negotiated Rate |
$3,580.20 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,784.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,591.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,526.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,347.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
OP
|
$3,978.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
909081856
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.42 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,381.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,187.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,983.50
|
| 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 |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Cigna of CA HMO |
$2,545.92
|
| Rate for Payer: Cigna of CA PPO |
$2,943.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,381.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,381.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,381.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,784.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,591.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$241.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,526.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,347.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,784.60
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,591.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,386.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,989.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,381.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,381.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,381.30
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
OP
|
$2,858.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
909081858
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$229.24 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$571.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,429.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,571.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,143.50
|
| 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 |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,286.40
|
| Rate for Payer: Cigna of CA HMO |
$1,829.12
|
| Rate for Payer: Cigna of CA PPO |
$2,114.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,429.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,429.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,429.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,000.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,143.20
|
| Rate for Payer: Galaxy Health WC |
$2,429.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,572.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$229.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,814.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$253.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,686.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,000.60
|
| Rate for Payer: Multiplan Commercial |
$2,143.50
|
| Rate for Payer: Networks By Design Commercial |
$1,857.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,429.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,143.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,714.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,429.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,429.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,429.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,429.30
|
|
|
HC INJ FORAMEN EPIDURAL C/T
|
Facility
|
IP
|
$3,978.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
909081855
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.60 |
| Max. Negotiated Rate |
$3,580.20 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,784.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,591.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,526.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,347.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
|
|
HC INJ FORAMEN EPIDURAL C/T
|
Facility
|
OP
|
$3,978.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
909081855
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$265.74 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| 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 |
$1,790.10
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Cigna of CA HMO |
$2,545.92
|
| Rate for Payer: Cigna of CA PPO |
$2,943.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,784.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$265.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,526.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| 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 |
$3,381.30
|
| 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 |
$2,386.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,989.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC INJ FORAMEN EPIDURAL L/S
|
Facility
|
IP
|
$3,978.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
909081857
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.60 |
| Max. Negotiated Rate |
$3,580.20 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,784.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,591.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,526.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,347.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
|
|
HC INJ FORAMEN EPIDURAL L/S
|
Facility
|
OP
|
$3,978.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
909081857
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$246.54 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| 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 |
$1,790.10
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Cigna of CA HMO |
$2,545.92
|
| Rate for Payer: Cigna of CA PPO |
$2,943.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,784.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$246.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,526.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$272.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| 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 |
$3,381.30
|
| 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 |
$2,386.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,989.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC INJ INTER CRV/THRC WGUID
|
Facility
|
IP
|
$4,377.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
907262321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$875.40 |
| Max. Negotiated Rate |
$3,939.30 |
| Rate for Payer: Adventist Health Commercial |
$875.40
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,501.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,063.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,750.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,750.80
|
| Rate for Payer: Galaxy Health WC |
$3,720.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,626.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,939.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,779.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,582.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.40
|
| Rate for Payer: Multiplan Commercial |
$3,282.75
|
| Rate for Payer: Networks By Design Commercial |
$2,845.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,720.45
|
|
|
HC INJ INTER CRV/THRC WGUID
|
Facility
|
OP
|
$4,377.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
907262321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$875.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$907.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 |
$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 |
$1,402.00
|
| 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 |
$1,969.65
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,501.60
|
| Rate for Payer: Cigna of CA HMO |
$2,801.28
|
| Rate for Payer: Cigna of CA PPO |
$3,238.98
|
| 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 |
$3,063.90
|
| 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 |
$3,720.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,626.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,939.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$384.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,779.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$3,282.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,845.05
|
| 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 |
$3,720.45
|
| 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 |
$2,626.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,188.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
OP
|
$3,978.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$254.22 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$907.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 |
$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 |
$1,402.00
|
| 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 |
$1,790.10
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Cigna of CA HMO |
$2,545.92
|
| Rate for Payer: Cigna of CA PPO |
$2,943.72
|
| 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 |
$2,784.60
|
| 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 |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$254.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,526.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| 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 |
$3,381.30
|
| 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 |
$2,386.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,989.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
IP
|
$3,978.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.60 |
| Max. Negotiated Rate |
$3,580.20 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,784.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,591.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,526.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,347.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
|
|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
IP
|
$4,991.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$998.20 |
| Max. Negotiated Rate |
$4,491.90 |
| Rate for Payer: Adventist Health Commercial |
$998.20
|
| Rate for Payer: Cash Price |
$2,245.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,992.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,493.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,996.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,996.40
|
| Rate for Payer: Galaxy Health WC |
$4,242.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,994.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,491.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,169.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,944.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.20
|
| Rate for Payer: Multiplan Commercial |
$3,743.25
|
| Rate for Payer: Networks By Design Commercial |
$3,244.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,242.35
|
|
