|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
510
|
| 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: Kaiser Permanente of CA Medi-Cal |
$192.79
|
| 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
|
450
|
| Min. Negotiated Rate |
$35.62 |
| 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: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care 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: Blue Distinction 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: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| 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) Other |
$379.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (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 Medi-Cal |
$35.62
|
| 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: Riverside University Health System 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
|
IP
|
$506.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
260
|
| 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: Kaiser Permanente of CA Medi-Cal |
$192.79
|
| 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
|
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: Kaiser Permanente of CA Medi-Cal |
$192.79
|
| 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
|
260
|
| Min. Negotiated Rate |
$35.62 |
| 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: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care 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: Blue Distinction 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: 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: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| 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) Other |
$379.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.23
|
| Rate for Payer: Inland Empire Health Plan (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 Medi-Cal |
$35.62
|
| 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: Riverside University Health System 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 |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| 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
|
750
|
| Min. Negotiated Rate |
$35.62 |
| 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: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care 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: Blue Distinction 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: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| 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) Other |
$379.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.23
|
| Rate for Payer: Inland Empire Health Plan (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 Medi-Cal |
$35.62
|
| 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: Riverside University Health System 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
|
450
|
| 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: Kaiser Permanente of CA Medi-Cal |
$192.79
|
| 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 TRIGGER POINT 1 OR 2
|
Facility
|
OP
|
$1,459.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$99.73 |
| 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: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care 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: Blue Distinction Transplant |
$875.40
|
| Rate for Payer: Blue Shield of California Commercial |
$917.71
|
| Rate for Payer: Blue Shield of California EPN |
$713.45
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,167.20
|
| Rate for Payer: Cigna of CA HMO |
$933.76
|
| Rate for Payer: Cigna of CA PPO |
$1,079.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| 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 |
$1,240.15
|
| Rate for Payer: Global Benefits Group Commercial |
$875.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,313.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,094.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$610.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.80
|
| 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 |
$1,094.25
|
| Rate for Payer: Networks By Design Commercial |
$948.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,240.15
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$875.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$875.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$729.50
|
| Rate for Payer: United Healthcare All Other HMO |
$729.50
|
| Rate for Payer: United Healthcare HMO Rider |
$729.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$729.50
|
| 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 INJECT TRIGGER POINT 1 OR 2
|
Facility
|
OP
|
$1,459.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$875.40
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,167.20
|
| Rate for Payer: Cigna of CA PPO |
$1,079.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| 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 |
$1,240.15
|
| Rate for Payer: Global Benefits Group Commercial |
$875.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,313.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,094.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$610.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.80
|
| 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 |
$1,094.25
|
| Rate for Payer: Networks By Design Commercial |
$948.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,240.15
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$875.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| 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 INJECT TRIGGER POINT 1 OR 2
|
Facility
|
IP
|
$1,459.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.80 |
| Max. Negotiated Rate |
$1,313.10 |
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,167.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$583.60
|
| Rate for Payer: Galaxy Health WC |
$1,240.15
|
| Rate for Payer: Global Benefits Group Commercial |
$875.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,313.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.80
|
| Rate for Payer: Multiplan Commercial |
$1,094.25
|
| Rate for Payer: Networks By Design Commercial |
$948.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,240.15
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
IP
|
$1,459.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$291.80 |
| Max. Negotiated Rate |
$1,313.10 |
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,167.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$583.60
|
| Rate for Payer: Galaxy Health WC |
$1,240.15
|
| Rate for Payer: Global Benefits Group Commercial |
$875.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,313.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.80
|
| Rate for Payer: Multiplan Commercial |
$1,094.25
|
| Rate for Payer: Networks By Design Commercial |
$948.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,240.15
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
OP
|
$1,459.00
|
|
|
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 Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care 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: Blue Distinction Transplant |
$875.40
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,167.20
|
| Rate for Payer: Cigna of CA PPO |
$1,079.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| 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 |
$1,240.15
|
| Rate for Payer: Global Benefits Group Commercial |
$875.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,313.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,094.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.80
|
| 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 |
$1,094.25
|
| Rate for Payer: Networks By Design Commercial |
$948.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,240.15
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$875.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$729.50
|
| Rate for Payer: United Healthcare All Other HMO |
$729.50
|
| Rate for Payer: United Healthcare HMO Rider |
$729.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$729.50
|
| 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 INJECT TRIGGER POINT 1 OR 2
|
Facility
|
IP
|
$1,459.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$291.80 |
| Max. Negotiated Rate |
$1,313.10 |
| Rate for Payer: Cash Price |
$656.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,167.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$583.60
|
| Rate for Payer: Galaxy Health WC |
$1,240.15
|
| Rate for Payer: Global Benefits Group Commercial |
$875.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,313.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.80
|
| Rate for Payer: Multiplan Commercial |
$1,094.25
|
| Rate for Payer: Networks By Design Commercial |
$948.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,240.15
|
|
|
HC INJECT W/FLUOR, EVAL CV DEVICE
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
909081842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$764.40
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$267.80
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,019.20
|
| Rate for Payer: Cigna of CA PPO |
$942.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$1,082.90
|
| Rate for Payer: Global Benefits Group Commercial |
$764.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,146.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$955.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: InnovAge PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$849.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$254.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$955.50
|
| Rate for Payer: Networks By Design Commercial |
$828.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,082.90
|
| Rate for Payer: Prime Health Services Medicare |
$283.87
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$764.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC INJECT W/FLUOR, EVAL CV DEVICE
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
909081842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$254.80 |
| Max. Negotiated Rate |
$1,146.60 |
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,019.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$509.60
|
| Rate for Payer: Galaxy Health WC |
$1,082.90
|
| Rate for Payer: Global Benefits Group Commercial |
$764.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,146.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$849.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$254.80
|
| Rate for Payer: Multiplan Commercial |
$955.50
|
| Rate for Payer: Networks By Design Commercial |
$828.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,082.90
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
OP
|
$3,008.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
909081856
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.68 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,556.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,654.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,654.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,804.80
|
| 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: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,406.40
|
| Rate for Payer: Cigna of CA PPO |
$2,225.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,556.80
|
| Rate for Payer: Dignity Health Media |
$2,556.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,707.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,256.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,052.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.60
|
| Rate for Payer: Multiplan Commercial |
$2,256.00
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,203.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,804.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,556.80
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
909081856
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$601.60 |
| Max. Negotiated Rate |
$2,707.20 |
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,146.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.60
|
| Rate for Payer: Multiplan Commercial |
$2,256.00
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
909081858
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$523.20 |
| Max. Negotiated Rate |
$2,354.40 |
| Rate for Payer: Cash Price |
$1,177.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,092.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,046.40
|
| Rate for Payer: Galaxy Health WC |
$2,223.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,354.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$996.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.20
|
| Rate for Payer: Multiplan Commercial |
$1,962.00
|
| Rate for Payer: Networks By Design Commercial |
$1,700.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,223.60
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
909081858
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$253.23 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,223.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,438.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,438.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,569.60
|
| 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: Cash Price |
$1,177.20
|
| Rate for Payer: Cash Price |
$1,177.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,092.80
|
| Rate for Payer: Cigna of CA PPO |
$1,935.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,223.60
|
| Rate for Payer: Dignity Health Media |
$2,223.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,223.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,046.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,046.40
|
| Rate for Payer: Galaxy Health WC |
$2,223.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,354.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,962.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$915.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.20
|
| Rate for Payer: Multiplan Commercial |
$1,962.00
|
| Rate for Payer: Networks By Design Commercial |
$1,700.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,223.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,046.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,569.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,223.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,223.60
|
|
|
HC INJ FORAMEN EPIDURAL C/T
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
909081855
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$601.60 |
| Max. Negotiated Rate |
$2,707.20 |
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,146.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.60
|
| Rate for Payer: Multiplan Commercial |
$2,256.00
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
|
|
HC INJ FORAMEN EPIDURAL C/T
|
Facility
|
OP
|
$3,008.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
909081855
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$293.55 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,804.80
|
| 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 |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,406.40
|
| Rate for Payer: Cigna of CA PPO |
$2,225.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| 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 |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,707.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,256.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (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 |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.60
|
| 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 |
$2,256.00
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,804.80
|
| 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 INJ FORAMEN EPIDURAL L/S
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
909081857
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$601.60 |
| Max. Negotiated Rate |
$2,707.20 |
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,146.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.60
|
| Rate for Payer: Multiplan Commercial |
$2,256.00
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
|
|
HC INJ FORAMEN EPIDURAL L/S
|
Facility
|
OP
|
$3,008.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
909081857
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$272.35 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,804.80
|
| 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 |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,406.40
|
| Rate for Payer: Cigna of CA PPO |
$2,225.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| 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 |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,707.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,256.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (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 |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.60
|
| 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 |
$2,256.00
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,804.80
|
| 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 INJ INTER CRV/THRC WGUID
|
Facility
|
IP
|
$3,310.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
907262321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$662.00 |
| Max. Negotiated Rate |
$2,979.00 |
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,648.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,324.00
|
| Rate for Payer: Galaxy Health WC |
$2,813.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,986.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,979.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,207.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,261.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$662.00
|
| Rate for Payer: Multiplan Commercial |
$2,482.50
|
| Rate for Payer: Networks By Design Commercial |
$2,151.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,813.50
|
|
|
HC INJ INTER CRV/THRC WGUID
|
Facility
|
OP
|
$3,310.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
907262321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$424.42 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$864.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,986.00
|
| 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 |
$864.04
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,648.00
|
| Rate for Payer: Cigna of CA PPO |
$2,449.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$2,813.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,986.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,979.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,482.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,425.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: InnovAge PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,207.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$662.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$2,482.50
|
| Rate for Payer: Networks By Design Commercial |
$2,151.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,813.50
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health System MISP |
$950.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,986.00
|
| 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 |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
