|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
OP
|
$1,623.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$324.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| 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 |
$597.61
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,298.40
|
| Rate for Payer: Cigna of CA HMO |
$1,038.72
|
| Rate for Payer: Cigna of CA PPO |
$1,201.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,379.55
|
| Rate for Payer: Global Benefits Group Commercial |
$973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,460.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: InnovAge PACE Commercial |
$562.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,082.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,217.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,054.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$375.07
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,379.55
|
| Rate for Payer: Prime Health Services Medicare |
$397.57
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$412.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$973.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.50
|
| Rate for Payer: United Healthcare All Other HMO |
$811.50
|
| Rate for Payer: United Healthcare HMO Rider |
$811.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$811.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
IP
|
$1,623.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,460.70 |
| Rate for Payer: Adventist Health Commercial |
$324.60
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,298.40
|
| Rate for Payer: 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
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
OP
|
$1,623.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$665.43
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| 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 |
$597.61
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,298.40
|
| Rate for Payer: Cigna of CA HMO |
$1,038.72
|
| Rate for Payer: Cigna of CA PPO |
$1,201.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,379.55
|
| Rate for Payer: Global Benefits Group Commercial |
$973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,460.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: InnovAge PACE Commercial |
$562.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,082.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,217.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,054.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$375.07
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,379.55
|
| Rate for Payer: Prime Health Services Medicare |
$397.57
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$412.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$973.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$973.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJECTION VITREOUS SUBSTITUTE
|
Facility
|
OP
|
$8,217.00
|
|
|
Service Code
|
CPT 67025
|
| Hospital Charge Code |
950510062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,395.30 |
| Rate for Payer: Adventist Health Commercial |
$1,643.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$3,697.65
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,573.60
|
| Rate for Payer: Cigna of CA HMO |
$5,258.88
|
| Rate for Payer: Cigna of CA PPO |
$6,080.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| 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 |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,395.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,752.56
|
| 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 |
$5,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$961.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.40
|
| 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 |
$6,162.75
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$5,341.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: Prime Health Services Medicare |
$3,071.77
|
| 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 |
$4,930.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,108.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,108.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,108.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,108.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| 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 VITREOUS SUBSTITUTE
|
Facility
|
IP
|
$8,217.00
|
|
|
Service Code
|
CPT 67025
|
| Hospital Charge Code |
950510062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,643.40 |
| Max. Negotiated Rate |
$7,395.30 |
| Rate for Payer: Adventist Health Commercial |
$1,643.40
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,573.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,395.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,086.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.40
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Networks By Design Commercial |
$5,341.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
|
|
HC INJECT SINUS TRACT; THERAPEUTIC
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
909020500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.86 |
| Max. Negotiated Rate |
$3,601.80 |
| Rate for Payer: Adventist Health Commercial |
$800.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,882.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,937.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,350.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2,429.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,588.79
|
| Rate for Payer: Cash Price |
$1,800.90
|
| Rate for Payer: Cash Price |
$1,800.90
|
| Rate for Payer: Cash Price |
$1,800.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,201.60
|
| Rate for Payer: Cigna of CA HMO |
$2,561.28
|
| Rate for Payer: Cigna of CA PPO |
$2,961.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$3,401.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,401.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,601.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$181.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: InnovAge PACE Commercial |
$2,823.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,669.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,522.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$3,001.50
|
| Rate for Payer: Networks By Design Commercial |
$2,601.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Prime Health Services Commercial |
$3,401.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,995.04
|
| Rate for Payer: Riverside University Health System MISP |
$2,070.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,401.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,401.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,001.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,001.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,001.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,001.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC INJECT SINUS TRACT; THERAPEUTIC
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
909020500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$800.40 |
| Max. Negotiated Rate |
$3,601.80 |
| Rate for Payer: Adventist Health Commercial |
$800.40
|
| Rate for Payer: Cash Price |
$1,800.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,201.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,600.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,600.80
|
| Rate for Payer: Galaxy Health WC |
$3,401.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,401.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,601.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,669.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,524.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,477.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.40
|
| Rate for Payer: Multiplan Commercial |
$3,001.50
|
| Rate for Payer: Networks By Design Commercial |
$2,601.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,401.70
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: 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 Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| 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 |
$90.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| 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 |
$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 |
$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 |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.25
|
| 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 |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| 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 |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.43
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| 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 |
$284.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.52
|
| 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 |
$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 INJECT THER/PROP/DIAG SC/IM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: 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 Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| 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
|
771
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$287.86
|
| 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 |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$289.61
|
| 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 |
$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 |
$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 |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.25
|
| 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 |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| 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 |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.43
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| 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 |
$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 |
$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 INJECT THER/PROP/DIAG SC/IM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$287.86
|
| 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 |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$289.61
|
| 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 |
$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 |
$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 |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.25
|
| 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 |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| 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 |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.43
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| 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 |
$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 |
$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 INJECT THER/PROP/DIAG SC/IM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$287.86
|
| 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 |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Cigna of CA HMO |
$303.36
|
| Rate for Payer: Cigna of CA PPO |
$350.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$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 |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.25
|
| 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 |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| 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 |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.43
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| 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 |
$284.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 INJECT THER/PROP/DIAG SC/IM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: 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 Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: 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 Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| 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
|
450
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: 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 Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| 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
|
450
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$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 |
$144.09
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Cigna of CA HMO |
$303.36
|
| Rate for Payer: Cigna of CA PPO |
$350.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$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 |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| 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 |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| 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 |
$355.50
|
| Rate for Payer: Multiplan WC |
$144.09
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.43
|
| Rate for Payer: Preferred Health Network WC |
$147.03
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| Rate for Payer: Prime Health Services Medicare |
$95.86
|
| Rate for Payer: Prime Health Services WC |
$142.62
|
| Rate for Payer: Riverside University Health System MISP |
$99.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.00
|
| Rate for Payer: United Healthcare All Other HMO |
$237.00
|
| Rate for Payer: United Healthcare HMO Rider |
$237.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 INJECT THER/PROP/DIAG SC/IM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$287.86
|
| 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 |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$289.61
|
| 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 |
$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 |
$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 |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.25
|
| 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 |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| 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 |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.43
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| 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 |
$284.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 INJECT THER/PROP/DIAG SC/IM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$144.09
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| 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 |
$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 |
$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 |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.25
|
| 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 |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| 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 |
$355.50
|
| Rate for Payer: Multiplan WC |
$144.09
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.43
|
| Rate for Payer: Preferred Health Network WC |
$147.03
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| Rate for Payer: Prime Health Services Medicare |
$95.86
|
| Rate for Payer: Prime Health Services WC |
$142.62
|
| Rate for Payer: Riverside University Health System MISP |
$99.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.00
|
| Rate for Payer: United Healthcare All Other HMO |
$237.00
|
| Rate for Payer: United Healthcare HMO Rider |
$237.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 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: 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 Permanente of CA Commercial/Self Funded |
$1,287.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$735.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,194.67
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,287.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$735.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,194.67
|
| 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
|
450
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| 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 |
$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 |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| 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 |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: InnovAge PACE Commercial |
$562.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,287.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| 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 |
$375.07
|
| 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 |
$397.57
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$412.58
|
| 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 |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,287.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$735.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,194.67
|
| 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
|
|
