|
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 |
$1,296.50 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,432.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,426.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$3,223.35
|
| Rate for Payer: Cash Price |
$3,223.35
|
| Rate for Payer: Cash Price |
$3,223.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,655.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,297.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,511.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,433.90
|
| Rate for Payer: Heritage Provider Network Senior |
$3,089.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,771.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,296.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,888.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,790.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$5,372.25
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,762.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,762.68
|
| 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 |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
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: Aetna of CA Non-Gatekeeper |
$4,612.97
|
| Rate for Payer: Cash Price |
$3,223.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,849.35
|
| Rate for Payer: Heritage Provider Network Senior |
$4,849.35
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
361
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$687.75 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$590.55
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.81
|
| Rate for Payer: Heritage Provider Network Senior |
$620.81
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
361
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$566.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$596.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$567.62
|
| Rate for Payer: Heritage Provider Network Senior |
$485.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$750.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$434.27
|
| Rate for Payer: TriValley Medical Group Senior |
$434.27
|
| 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 |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$566.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$435.57
|
| Rate for Payer: Blue Shield of California EPN |
$346.63
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$596.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$596.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| 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) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$437.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$550.20
|
| Rate for Payer: TriValley Medical Group Senior |
$550.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
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: Aetna of CA Non-Gatekeeper |
$590.55
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.81
|
| Rate for Payer: Heritage Provider Network Senior |
$620.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
|
|
HC INJECTION VITREOUS SUBSTITUTE
|
Facility
|
OP
|
$8,217.00
|
|
|
Service Code
|
CPT 67025
|
| Hospital Charge Code |
950510062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,487.28 |
| Max. Negotiated Rate |
$6,162.75 |
| Rate for Payer: Adventist Health Commercial |
$1,643.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,078.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,903.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,106.03
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,341.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,341.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,968.25
|
| 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) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,919.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,487.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,054.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$6,162.75
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,930.20
|
| Rate for Payer: TriValley Medical Group Senior |
$4,930.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
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: Aetna of CA Non-Gatekeeper |
$5,291.75
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,562.91
|
| Rate for Payer: Heritage Provider Network Senior |
$5,562.91
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$2,577.29
|
| Rate for Payer: Cash Price |
$1,800.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,709.35
|
| Rate for Payer: Heritage Provider Network Senior |
$2,709.35
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$724.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$800.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,473.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$1,800.90
|
| Rate for Payer: Cash Price |
$1,800.90
|
| Rate for Payer: Cash Price |
$1,800.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,995.60
|
| 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) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,908.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$724.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,294.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$3,001.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,995.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,995.60
|
| 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 |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
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: Aetna of CA Non-Gatekeeper |
$280.78
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.17
|
| Rate for Payer: Heritage Provider Network Senior |
$295.17
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$280.78
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.17
|
| Rate for Payer: Heritage Provider Network Senior |
$295.17
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$87.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$207.10
|
| Rate for Payer: Blue Shield of California EPN |
$164.81
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$283.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$92.60
|
| 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) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$207.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$327.00
|
| Rate for Payer: Multiplan WC |
$144.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$261.60
|
| Rate for Payer: TriValley Medical Group Senior |
$261.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
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 |
$78.92 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$87.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| 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 |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$283.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$92.60
|
| 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) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$207.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$327.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$101.86
|
| Rate for Payer: TriValley Medical Group Senior |
$92.60
|
| 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 |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
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 |
$116.93 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$399.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$306.85
|
| Rate for Payer: Blue Shield of California EPN |
$244.19
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| 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) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$308.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$387.60
|
| Rate for Payer: TriValley Medical Group Senior |
$387.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$399.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$399.87
|
| Rate for Payer: Heritage Provider Network Senior |
$485.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$750.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$434.27
|
| Rate for Payer: TriValley Medical Group Senior |
$434.27
|
| 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 |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$416.02
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.34
|
| Rate for Payer: Heritage Provider Network Senior |
$437.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
|
|
HC INJECT TRIGGER POINT 1 OR 2
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
909000260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$416.02
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.34
|
| Rate for Payer: Heritage Provider Network Senior |
$437.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
|
|
HC INJECT W/FLUOR, EVAL CV DEVICE
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
909081842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Adventist Health Commercial |
$98.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.85
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.08
|
| Rate for Payer: Heritage Provider Network Senior |
$333.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.00
|
| Rate for Payer: Multiplan Commercial |
$369.00
|
|
|
HC INJECT W/FLUOR, EVAL CV DEVICE
|
Facility
|
OP
|
$492.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
909081842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$98.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$304.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$319.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$273.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.55
|
| Rate for Payer: Heritage Provider Network Senior |
$336.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$519.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$314.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$369.00
|
| Rate for Payer: Multiplan WC |
$426.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$300.93
|
| Rate for Payer: TriValley Medical Group Senior |
$300.93
|
| 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 |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
OP
|
$3,673.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
909081856
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$664.81 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$734.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,269.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,122.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,020.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,754.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$1,652.85
|
| Rate for Payer: Cash Price |
$1,652.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,387.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,122.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,122.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,122.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,203.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,273.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2,273.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,752.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,571.10
|
| Rate for Payer: Multiplan Commercial |
$2,754.75
|
| 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 |
$3,122.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,122.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,122.05
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
IP
|
$3,673.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
909081856
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$664.81 |
| Max. Negotiated Rate |
$2,754.75 |
| Rate for Payer: Adventist Health Commercial |
$734.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,365.41
|
| Rate for Payer: Cash Price |
$1,652.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,486.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2,486.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.25
|
| Rate for Payer: Multiplan Commercial |
$2,754.75
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
OP
|
$2,858.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
909081858
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$517.30 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$571.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,766.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,429.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,571.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,143.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$1,286.10
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,857.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,429.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,429.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,429.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,714.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,769.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,769.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,363.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$517.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,000.60
|
| Rate for Payer: Multiplan Commercial |
$2,143.50
|
| 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 |
$2,429.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,429.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,429.30
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
IP
|
$2,858.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
909081858
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$517.30 |
| Max. Negotiated Rate |
$2,143.50 |
| Rate for Payer: Adventist Health Commercial |
$571.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,840.55
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,934.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,934.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$517.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.50
|
| Rate for Payer: Multiplan Commercial |
$2,143.50
|
|
|
HC INJ FORAMEN EPIDURAL C/T
|
Facility
|
IP
|
$3,673.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
909081855
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$664.81 |
| Max. Negotiated Rate |
$2,754.75 |
| Rate for Payer: Adventist Health Commercial |
$734.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,365.41
|
| Rate for Payer: Cash Price |
$1,652.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,486.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2,486.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.25
|
| Rate for Payer: Multiplan Commercial |
$2,754.75
|
|
