|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$488.96
|
| Rate for Payer: Cigna of CA PPO |
$565.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$382.00
|
| Rate for Payer: United Healthcare All Other HMO |
$382.00
|
| Rate for Payer: United Healthcare HMO Rider |
$382.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$382.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.50 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$369.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$448.70
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$488.96
|
| Rate for Payer: Cigna of CA PPO |
$565.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC INJECTION ADMIN SYNAGIS
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
912190471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC INJECTION ADMIN SYNAGIS
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
912190471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$148.31 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.68
|
| Rate for Payer: Blue Shield of California Commercial |
$53.77
|
| Rate for Payer: Blue Shield of California EPN |
$35.11
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.43
|
| Rate for Payer: InnovAge PACE Commercial |
$135.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.43
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Prime Health Services Medicare |
$95.86
|
| Rate for Payer: Riverside University Health System MISP |
$99.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.00
|
| Rate for Payer: United Healthcare All Other HMO |
$44.00
|
| Rate for Payer: United Healthcare HMO Rider |
$44.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC INJECTION EYE DRUG
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
900501532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$671.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: Cigna of CA HMO |
$1,324.80
|
| Rate for Payer: Cigna of CA PPO |
$1,531.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Preferred Health Network WC |
$685.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,035.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,035.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC INJECTION EYE DRUG
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
900501532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
|
|
HC INJECTION FACIAL NERVE
|
Facility
|
OP
|
$2,548.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
900501174
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$2,582.00 |
| Rate for Payer: Adventist Health Commercial |
$509.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,547.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,165.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,401.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,911.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,556.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,016.65
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,038.40
|
| Rate for Payer: Cigna of CA HMO |
$1,630.72
|
| Rate for Payer: Cigna of CA PPO |
$1,885.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,165.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,165.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,165.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,019.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,019.20
|
| Rate for Payer: Galaxy Health WC |
$2,165.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,293.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,274.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,699.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$970.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,577.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,783.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,783.60
|
| Rate for Payer: Multiplan Commercial |
$1,911.00
|
| Rate for Payer: Networks By Design Commercial |
$1,656.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,165.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,019.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,528.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,274.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,274.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,274.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,274.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,165.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,165.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,165.80
|
|
|
HC INJECTION FACIAL NERVE
|
Facility
|
IP
|
$2,548.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
900501174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$2,293.20 |
| Rate for Payer: Adventist Health Commercial |
$509.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,038.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,019.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,019.20
|
| Rate for Payer: Galaxy Health WC |
$2,165.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,293.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,699.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$970.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,577.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.60
|
| Rate for Payer: Multiplan Commercial |
$1,911.00
|
| Rate for Payer: Networks By Design Commercial |
$1,656.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,165.80
|
|
|
HC INJECTION FACIAL NERVE
|
Facility
|
IP
|
$2,548.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
900501174
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$2,293.20 |
| Rate for Payer: Adventist Health Commercial |
$509.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,038.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,019.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,019.20
|
| Rate for Payer: Galaxy Health WC |
$2,165.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,293.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,699.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$970.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,577.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.60
|
| Rate for Payer: Multiplan Commercial |
$1,911.00
|
| Rate for Payer: Networks By Design Commercial |
$1,656.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,165.80
|
|
|
HC INJECTION FACIAL NERVE
|
Facility
|
OP
|
$2,548.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
900501174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$509.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,165.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,401.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,911.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,038.40
|
| Rate for Payer: Cigna of CA HMO |
$1,630.72
|
| Rate for Payer: Cigna of CA PPO |
$1,885.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,165.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,165.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,165.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,019.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,019.20
|
| Rate for Payer: Galaxy Health WC |
$2,165.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,293.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,274.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,699.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$970.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,577.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,783.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,783.60
|
| Rate for Payer: Multiplan Commercial |
$1,911.00
|
| Rate for Payer: Networks By Design Commercial |
$1,656.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,165.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,019.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,274.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,274.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,274.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,274.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,165.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,165.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,165.80
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$3,167.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$633.40 |
| Max. Negotiated Rate |
$2,850.30 |
| Rate for Payer: Adventist Health Commercial |
$633.40
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,533.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,266.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,266.80
|
| Rate for Payer: Galaxy Health WC |
$2,691.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,850.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,112.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,206.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,960.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.40
|
| Rate for Payer: Multiplan Commercial |
$2,375.25
|
| Rate for Payer: Networks By Design Commercial |
$2,058.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,691.95
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$3,167.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,298.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,533.60
|
| Rate for Payer: Cigna of CA HMO |
$2,026.88
|
| Rate for Payer: Cigna of CA PPO |
$2,343.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$2,691.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,850.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,112.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$2,375.25
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,058.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$2,691.95
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,900.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,900.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$3,167.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$633.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,533.60
|
| Rate for Payer: Cigna of CA HMO |
$2,026.88
|
| Rate for Payer: Cigna of CA PPO |
$2,343.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$2,691.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,850.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,112.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$2,375.25
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,058.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$2,691.95
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,900.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,583.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,583.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,583.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,583.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$3,167.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$633.40 |
| Max. Negotiated Rate |
$2,850.30 |
| Rate for Payer: Adventist Health Commercial |
$633.40
|
| Rate for Payer: Cash Price |
$1,425.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,533.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,266.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,266.80
|
| Rate for Payer: Galaxy Health WC |
$2,691.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,850.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,112.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,206.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,960.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.40
|
| Rate for Payer: Multiplan Commercial |
$2,375.25
|
| Rate for Payer: Networks By Design Commercial |
$2,058.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,691.95
|
|
|
HC INJECTION 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: 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 Permanente of CA Commercial/Self Funded |
$3,316.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,894.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,078.29
|
| 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 |
$4,475.70 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| 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 |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| 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: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,316.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| 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 |
$1,131.20
|
| 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 |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| 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 |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
|
IP
|
$4,973.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$994.60 |
| Max. Negotiated Rate |
$4,475.70 |
| Rate for Payer: Adventist Health Commercial |
$994.60
|
| Rate for Payer: Cash Price |
$2,237.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,978.40
|
| Rate for Payer: 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 Permanente of CA Commercial/Self Funded |
$3,316.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,894.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,078.29
|
| 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
|
361
|
| Min. Negotiated Rate |
$276.63 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$994.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| 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 |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| 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: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$276.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,316.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| 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 |
$1,131.20
|
| 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 |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,983.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| 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 |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| 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 |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: InnovAge PACE Commercial |
$4,346.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,862.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,757.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,883.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| 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 |
$2,897.90
|
| 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 |
$3,071.77
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,187.69
|
| 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 |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$5,862.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,348.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,440.39
|
| 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 |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,983.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,481.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,953.34
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| 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 |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| 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 |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$352.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: InnovAge PACE Commercial |
$3,721.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,615.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,983.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,324.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| 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 |
$2,481.19
|
| 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 |
$2,630.06
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,729.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,950.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| 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 |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$6,615.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,778.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,139.24
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,082.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$618.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,004.64
|
| 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
|
|
