|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
IP
|
$3,760.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.00 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.00
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$2,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
IP
|
$3,760.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$752.00 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.00
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$2,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
OP
|
$3,760.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,256.00
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: Cigna of CA PPO |
$2,782.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,820.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Innovage PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$2,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,256.00
|
| Rate for Payer: Riverside University Health MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,880.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,880.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,880.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,880.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
OP
|
$3,760.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,256.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: Cigna of CA PPO |
$2,782.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,820.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: IEHP medi-cal |
$1,879.07
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Innovage PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$2,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,256.00
|
| Rate for Payer: Riverside University Health MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJECTION TREATMENT OF EYE
|
Facility
OP
|
$7,099.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
900506030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,389.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,259.40
|
| Rate for Payer: Caremore Medicare Advantage |
$2,911.63
|
| Rate for Payer: Cash Price |
$3,194.55
|
| Rate for Payer: Cash Price |
$3,194.55
|
| Rate for Payer: Cash Price |
$3,194.55
|
| Rate for Payer: Cash Price |
$3,194.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,679.20
|
| Rate for Payer: Cigna of CA PPO |
$5,253.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$6,034.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,259.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,389.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,324.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Innovage PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,735.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$5,324.25
|
| Rate for Payer: Networks By Design Commercial |
$4,614.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,034.15
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,259.40
|
| Rate for Payer: Riverside University Health MISP |
$3,202.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,259.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,549.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,549.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,549.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,549.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC INJECTION TREATMENT OF EYE
|
Facility
IP
|
$7,099.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
900506030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,419.80 |
| Max. Negotiated Rate |
$6,389.10 |
| Rate for Payer: Cash Price |
$3,194.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,679.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,839.60
|
| Rate for Payer: Galaxy Health WC |
$6,034.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,259.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,389.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,735.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.80
|
| Rate for Payer: Multiplan Commercial |
$5,324.25
|
| Rate for Payer: Networks By Design Commercial |
$4,614.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,034.15
|
|
|
HC INJECTION TREATMENT OF NERVE
|
Facility
OP
|
$7,499.00
|
|
|
Service Code
|
CPT 64610
|
| Hospital Charge Code |
909000272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,499.80 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,412.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,499.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,412.38
|
| Rate for Payer: Cash Price |
$3,374.55
|
| Rate for Payer: Cash Price |
$3,374.55
|
| Rate for Payer: Cash Price |
$3,374.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,999.20
|
| Rate for Payer: Cigna of CA PPO |
$5,549.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$6,374.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,499.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,749.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,624.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,956.30
|
| Rate for Payer: IEHP medi-cal |
$3,980.43
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Innovage PACE Commercial |
$3,618.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,001.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,499.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,232.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$5,624.25
|
| Rate for Payer: Networks By Design Commercial |
$4,874.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,374.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,557.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,499.40
|
| Rate for Payer: Riverside University Health MISP |
$2,653.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,499.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC INJECTION TREATMENT OF NERVE
|
Facility
IP
|
$7,499.00
|
|
|
Service Code
|
CPT 64610
|
| Hospital Charge Code |
909000272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,499.80 |
| Max. Negotiated Rate |
$6,749.10 |
| Rate for Payer: Cash Price |
$3,374.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,999.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,999.60
|
| Rate for Payer: Galaxy Health WC |
$6,374.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,499.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,749.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,001.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,499.80
|
| Rate for Payer: Multiplan Commercial |
$5,624.25
|
| Rate for Payer: Networks By Design Commercial |
$4,874.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,374.15
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$891.00
|
| Rate for Payer: Blue Shield of California Commercial |
$934.06
|
| Rate for Payer: Blue Shield of California EPN |
$726.16
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Cigna of CA HMO |
$950.40
|
| Rate for Payer: Cigna of CA PPO |
$1,098.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,113.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: IEHP medi-cal |
$610.60
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Innovage PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: Riverside University Health MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$742.50
|
| Rate for Payer: United Healthcare All Other HMO |
$742.50
|
| Rate for Payer: United Healthcare HMO Rider |
$742.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$742.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$891.00
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Cigna of CA PPO |
$1,098.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,113.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Innovage PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: Riverside University Health MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$742.50
|
| Rate for Payer: United Healthcare All Other HMO |
$742.50
|
| Rate for Payer: United Healthcare HMO Rider |
$742.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$742.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
|
|
HC INJECTION VITREOUS SUBSTITUTE
|
Facility
IP
|
$6,637.00
|
|
|
Service Code
|
CPT 67025
|
| Hospital Charge Code |
950510062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,327.40 |
| Max. Negotiated Rate |
$5,973.30 |
| Rate for Payer: Cash Price |
$2,986.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,309.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,654.80
|
| Rate for Payer: Galaxy Health WC |
$5,641.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,982.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,973.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,426.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,327.40
|
| Rate for Payer: Multiplan Commercial |
$4,977.75
|
| Rate for Payer: Networks By Design Commercial |
$4,314.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,641.45
|
|
|
HC INJECTION VITREOUS SUBSTITUTE
|
Facility
OP
|
$6,637.00
|
|
|
Service Code
|
CPT 67025
|
| Hospital Charge Code |
950510062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,973.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,982.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,911.63
|
| Rate for Payer: Cash Price |
$2,986.65
|
| Rate for Payer: Cash Price |
$2,986.65
|
| Rate for Payer: Cash Price |
$2,986.65
|
| Rate for Payer: Cash Price |
$2,986.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,309.60
|
| Rate for Payer: Cigna of CA PPO |
$4,911.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$5,641.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,982.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,973.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,977.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Innovage PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,426.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,327.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$4,977.75
|
| Rate for Payer: Networks By Design Commercial |
$4,314.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,641.45
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,982.20
|
| Rate for Payer: Riverside University Health MISP |
$3,202.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,982.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,318.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,318.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,318.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,318.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC INJECT SINUS TRACT; THERAPEUTIC
|
Facility
OP
|
$3,026.00
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
909020500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$605.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,905.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,815.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,870.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,470.64
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Cash Price |
$1,361.70
|
| Rate for Payer: Cash Price |
$1,361.70
|
| Rate for Payer: Cash Price |
$1,361.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,420.80
|
| Rate for Payer: Cigna of CA HMO |
$1,936.64
|
| Rate for Payer: Cigna of CA PPO |
$2,239.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$2,572.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,815.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,723.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,269.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: IEHP medi-cal |
$3,143.98
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Innovage PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,018.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$2,269.50
|
| Rate for Payer: Networks By Design Commercial |
$1,966.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,572.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,815.60
|
| Rate for Payer: Riverside University Health MISP |
$2,095.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,815.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,815.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,513.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,513.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,513.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,513.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC INJECT SINUS TRACT; THERAPEUTIC
|
Facility
IP
|
$3,026.00
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
909020500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$605.20 |
| Max. Negotiated Rate |
$2,723.40 |
| Rate for Payer: Cash Price |
$1,361.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,420.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,210.40
|
| Rate for Payer: Galaxy Health WC |
$2,572.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,815.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,723.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,018.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.20
|
| Rate for Payer: Multiplan Commercial |
$2,269.50
|
| Rate for Payer: Networks By Design Commercial |
$1,966.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,572.10
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
OP
|
$506.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$88.02 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: BCBS Transplant Transplant |
$303.60
|
| Rate for Payer: Blue Shield of California Commercial |
$318.27
|
| Rate for Payer: Blue Shield of California EPN |
$247.43
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Central Health Plan Commercial |
$404.80
|
| Rate for Payer: Cigna of CA HMO |
$323.84
|
| Rate for Payer: Cigna of CA PPO |
$374.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$455.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$379.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: IEHP medi-cal |
$145.23
|
| Rate for Payer: IEHP Medicare Advantage |
$88.02
|
| Rate for Payer: Innovage PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$379.50
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$303.60
|
| Rate for Payer: Riverside University Health MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
OP
|
$506.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.02 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$303.60
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Central Health Plan Commercial |
$404.80
|
| Rate for Payer: Cigna of CA PPO |
$374.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$455.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$379.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$88.02
|
| Rate for Payer: Innovage PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$379.50
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$303.60
|
| Rate for Payer: Riverside University Health MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.00
|
| Rate for Payer: United Healthcare All Other HMO |
$253.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$253.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
OP
|
$506.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$88.02 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$303.60
|
| Rate for Payer: Blue Shield of California Commercial |
$318.27
|
| Rate for Payer: Blue Shield of California EPN |
$247.43
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Central Health Plan Commercial |
$404.80
|
| Rate for Payer: Cigna of CA HMO |
$323.84
|
| Rate for Payer: Cigna of CA PPO |
$374.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$455.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$379.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: IEHP medi-cal |
$145.23
|
| Rate for Payer: IEHP Medicare Advantage |
$88.02
|
| Rate for Payer: Innovage PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$379.50
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$303.60
|
| Rate for Payer: Riverside University Health MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.00
|
| Rate for Payer: United Healthcare All Other HMO |
$253.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$253.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
OP
|
$506.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.02 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: BCBS Transplant Transplant |
$303.60
|
| Rate for Payer: Blue Shield of California Commercial |
$318.27
|
| Rate for Payer: Blue Shield of California EPN |
$247.43
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Central Health Plan Commercial |
$404.80
|
| Rate for Payer: Cigna of CA HMO |
$323.84
|
| Rate for Payer: Cigna of CA PPO |
$374.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$455.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$379.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: IEHP medi-cal |
$145.23
|
| Rate for Payer: IEHP Medicare Advantage |
$88.02
|
| Rate for Payer: Innovage PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$379.50
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$303.60
|
| Rate for Payer: Riverside University Health MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.00
|
| Rate for Payer: United Healthcare All Other HMO |
$253.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$253.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
IP
|
$506.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$455.40 |
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Central Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.40
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$455.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$379.50
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
IP
|
$506.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$455.40 |
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Central Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.40
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$455.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$379.50
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
IP
|
$506.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$455.40 |
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Central Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.40
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$455.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$379.50
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
OP
|
$506.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$88.02 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: BCBS Transplant Transplant |
$303.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Central Health Plan Commercial |
$404.80
|
| Rate for Payer: Cigna of CA PPO |
$374.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$455.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$379.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: IEHP medi-cal |
$145.23
|
| Rate for Payer: IEHP Medicare Advantage |
$88.02
|
| Rate for Payer: Innovage PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$379.50
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$96.82
|
| Rate for Payer: Riverside University Health MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.00
|
| Rate for Payer: United Healthcare All Other HMO |
$253.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$253.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
IP
|
$506.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$455.40 |
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Central Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.40
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$455.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$379.50
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
|
