|
HC INJECTION FACIAL NERVE
|
Facility
|
IP
|
$1,291.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
900501174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.67 |
| Max. Negotiated Rate |
$968.25 |
| Rate for Payer: Adventist Health Commercial |
$258.20
|
| Rate for Payer: Cash Price |
$710.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.01
|
| Rate for Payer: Heritage Provider Network Senior |
$874.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.75
|
| Rate for Payer: Multiplan Commercial |
$968.25
|
|
|
HC INJECTION FACIAL NERVE
|
Facility
|
OP
|
$1,291.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
900501174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.67 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$258.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$690.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$886.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,097.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$710.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$710.05
|
| Rate for Payer: Cash Price |
$710.05
|
| Rate for Payer: Cash Price |
$710.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$839.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,097.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,097.35
|
| Rate for Payer: Dignity Health Senior |
$1,097.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$839.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.01
|
| Rate for Payer: Heritage Provider Network Senior |
$874.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$615.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$903.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.70
|
| Rate for Payer: Multiplan Commercial |
$968.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$464.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$427.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,097.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,097.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,097.35
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$966.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$174.85 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$653.98
|
| Rate for Payer: Heritage Provider Network Senior |
$653.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.50
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
IP
|
$966.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.85 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$653.98
|
| Rate for Payer: Heritage Provider Network Senior |
$653.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.50
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$966.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$663.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$627.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Senior |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$597.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,082.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,671.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,108.70
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$967.91
|
| Rate for Payer: TriValley Medical Group Senior |
$967.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
|
OP
|
$966.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$663.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$627.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Senior |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$653.98
|
| Rate for Payer: Heritage Provider Network Senior |
$653.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$460.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,108.70
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$347.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$371.41 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Adventist Health Commercial |
$410.40
|
| Rate for Payer: Cash Price |
$1,128.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,389.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,389.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.00
|
| Rate for Payer: Multiplan Commercial |
$1,539.00
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$371.41 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Adventist Health Commercial |
$410.40
|
| Rate for Payer: Cash Price |
$1,128.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,389.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,389.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.00
|
| Rate for Payer: Multiplan Commercial |
$1,539.00
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$410.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,409.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,128.60
|
| Rate for Payer: Cash Price |
$1,128.60
|
| Rate for Payer: Cash Price |
$1,128.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,333.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,333.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,389.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,389.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$978.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$1,539.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$738.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$679.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$410.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,409.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,128.60
|
| Rate for Payer: Cash Price |
$1,128.60
|
| Rate for Payer: Cash Price |
$1,128.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,333.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,231.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,270.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$260.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$1,539.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJECTION TREATMENT OF NERVE
|
Facility
|
OP
|
$7,163.00
|
|
|
Service Code
|
CPT 64610
|
| Hospital Charge Code |
909000272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,432.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,920.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,939.65
|
| Rate for Payer: Cash Price |
$3,939.65
|
| Rate for Payer: Cash Price |
$3,939.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,655.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Senior |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,297.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,481.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,433.90
|
| Rate for Payer: Heritage Provider Network Senior |
$3,051.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$332.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,714.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,296.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,853.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,790.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,126.30
|
| Rate for Payer: Multiplan Commercial |
$5,372.25
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,729.31
|
| Rate for Payer: TriValley Medical Group Senior |
$2,729.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC INJECTION TREATMENT OF NERVE
|
Facility
|
IP
|
$7,163.00
|
|
|
Service Code
|
CPT 64610
|
| Hospital Charge Code |
909000272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,296.50 |
| Max. Negotiated Rate |
$5,372.25 |
| Rate for Payer: Adventist Health Commercial |
$1,432.60
|
| Rate for Payer: Cash Price |
$3,939.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,849.35
|
| Rate for Payer: Heritage Provider Network Senior |
$4,849.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,296.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,790.75
|
| Rate for Payer: Multiplan Commercial |
$5,372.25
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$687.75 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.81
|
| Rate for Payer: Heritage Provider Network Senior |
$620.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$687.75 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.81
|
| Rate for Payer: Heritage Provider Network Senior |
$620.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$629.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$596.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Senior |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$596.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$375.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.81
|
| Rate for Payer: Heritage Provider Network Senior |
$620.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$437.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$431.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$472.59
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$329.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$303.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$629.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$596.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Senior |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$375.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$567.62
|
| Rate for Payer: Heritage Provider Network Senior |
$461.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$712.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$431.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$472.59
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$412.58
|
| Rate for Payer: TriValley Medical Group Senior |
$412.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJECTION VITREOUS SUBSTITUTE
|
Facility
|
IP
|
$8,217.00
|
|
|
Service Code
|
CPT 67025
|
| Hospital Charge Code |
950510062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,487.28 |
| Max. Negotiated Rate |
$6,162.75 |
| Rate for Payer: Adventist Health Commercial |
$1,643.40
|
| Rate for Payer: Cash Price |
$4,519.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,562.91
|
| Rate for Payer: Heritage Provider Network Senior |
$5,562.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,487.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,054.25
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
|
|
HC INJECTION VITREOUS SUBSTITUTE
|
Facility
|
OP
|
$8,217.00
|
|
|
Service Code
|
CPT 67025
|
| Hospital Charge Code |
950510062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$6,162.75 |
| Rate for Payer: Adventist Health Commercial |
$1,643.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,645.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$4,519.35
|
| Rate for Payer: Cash Price |
$4,519.35
|
| Rate for Payer: Cash Price |
$4,519.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,341.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Senior |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,341.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,897.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,562.91
|
| Rate for Payer: Heritage Provider Network Senior |
$5,562.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,919.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,487.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,332.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,054.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,651.35
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,956.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,720.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC INJECT SINUS TRACT; THERAPEUTIC
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
909020500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$724.36 |
| Max. Negotiated Rate |
$3,001.50 |
| Rate for Payer: Adventist Health Commercial |
$800.40
|
| Rate for Payer: Cash Price |
$2,201.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,709.35
|
| Rate for Payer: Heritage Provider Network Senior |
$2,709.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$724.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.50
|
| Rate for Payer: Multiplan Commercial |
$3,001.50
|
|
|
HC INJECT SINUS TRACT; THERAPEUTIC
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
909020500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$800.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,749.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,441.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,952.98
|
| Rate for Payer: Cash Price |
$2,201.10
|
| Rate for Payer: Cash Price |
$2,201.10
|
| Rate for Payer: Cash Price |
$2,201.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Senior |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,882.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,477.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,477.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,908.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,164.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,371.46
|
| Rate for Payer: Multiplan Commercial |
$3,001.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,882.11
|
| Rate for Payer: TriValley Medical Group Senior |
$1,882.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,001.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: Adventist Health Commercial |
$87.20
|
| Rate for Payer: Cash Price |
$239.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.17
|
| Rate for Payer: Heritage Provider Network Senior |
$295.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.00
|
| Rate for Payer: Multiplan Commercial |
$327.00
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: Adventist Health Commercial |
$87.20
|
| Rate for Payer: Cash Price |
$239.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.17
|
| Rate for Payer: Heritage Provider Network Senior |
$295.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.00
|
| Rate for Payer: Multiplan Commercial |
$327.00
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$87.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$233.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$299.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$239.80
|
| Rate for Payer: Cash Price |
$239.80
|
| Rate for Payer: Cash Price |
$239.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$283.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Senior |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$90.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.17
|
| Rate for Payer: Heritage Provider Network Senior |
$295.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.94
|
| Rate for Payer: Multiplan Commercial |
$327.00
|
| Rate for Payer: Multiplan WC |
$144.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$144.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$30.38 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$87.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$233.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$299.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$239.80
|
| Rate for Payer: Cash Price |
$239.80
|
| Rate for Payer: Cash Price |
$239.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$283.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Senior |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$90.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.88
|
| Rate for Payer: Heritage Provider Network Senior |
$269.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.94
|
| Rate for Payer: Multiplan Commercial |
$327.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$99.47
|
| Rate for Payer: TriValley Medical Group Senior |
$90.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Senior |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$375.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.34
|
| Rate for Payer: Heritage Provider Network Senior |
$437.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$308.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$431.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$472.59
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$232.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$213.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
