|
HC CEMENTOPLASTY
|
Facility
IP
|
$665.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909080999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.60
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
|
|
HC CEMENTOPLASTY
|
Facility
OP
|
$665.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909080999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$4,128.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$396.21
|
| Rate for Payer: BCBS Transplant Transplant |
$399.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$498.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: IEHP Medi-Cal |
$477.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$477.32
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$399.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.00
|
| 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 |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CENTRL MOTR STDY UPPER & LOWER
|
Facility
OP
|
$2,112.00
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
900600322
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$506.88 |
| Max. Negotiated Rate |
$2,411.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,411.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,306.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,258.33
|
| Rate for Payer: BCBS Transplant Transplant |
$1,267.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,248.19
|
| Rate for Payer: Blue Shield of California EPN |
$990.53
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cigna of CA HMO |
$1,351.68
|
| Rate for Payer: Cigna of CA PPO |
$1,562.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Dignity Health Media |
$1,306.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,763.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,306.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,306.33
|
| Rate for Payer: Galaxy Health WC |
$1,795.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,267.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,584.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,142.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,142.38
|
| Rate for Payer: IEHP Medi-Cal |
$2,116.25
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,116.25
|
| Rate for Payer: IEHP Medicare Advantage |
$1,306.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,408.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$789.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,306.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,645.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,750.48
|
| Rate for Payer: Multiplan Commercial |
$1,689.60
|
| Rate for Payer: Networks By Design Commercial |
$1,372.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,795.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,267.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,267.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,267.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1,306.33
|
|
|
HC CENTRL MOTR STDY UPPER & LOWER
|
Facility
IP
|
$2,112.00
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
900600322
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$506.88 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$844.80
|
| Rate for Payer: Galaxy Health WC |
$1,795.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,267.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,408.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$804.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.88
|
| Rate for Payer: Multiplan Commercial |
$1,689.60
|
| Rate for Payer: Networks By Design Commercial |
$1,372.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,795.20
|
|
|
HC CENTROMERE AB
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913527
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$110.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.01
|
| Rate for Payer: BCBS Transplant Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$14.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.26
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$19.76
|
| Rate for Payer: IEHP Medi-Cal |
$19.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$19.52
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC CEREBRAL BLOOD FLOW
|
Facility
OP
|
$3,689.00
|
|
|
Service Code
|
CPT 78610
|
| Hospital Charge Code |
909301412
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$3,135.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,031.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,197.91
|
| Rate for Payer: BCBS Transplant Transplant |
$2,213.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,180.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,730.14
|
| Rate for Payer: Cash Price |
$1,660.05
|
| Rate for Payer: Cash Price |
$1,660.05
|
| Rate for Payer: Cigna of CA HMO |
$2,360.96
|
| Rate for Payer: Cigna of CA PPO |
$2,729.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$3,135.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,213.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,766.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,107.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,107.54
|
| Rate for Payer: IEHP Medi-Cal |
$1,094.03
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,094.03
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,460.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$885.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$2,951.20
|
| Rate for Payer: Networks By Design Commercial |
$2,397.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,135.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,213.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,213.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,213.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.06
|
| Rate for Payer: United Healthcare All Other HMO |
$616.06
|
| Rate for Payer: United Healthcare HMO Rider |
$616.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC CEREBRAL BLOOD FLOW
|
Facility
IP
|
$3,689.00
|
|
|
Service Code
|
CPT 78610
|
| Hospital Charge Code |
909301412
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$885.36 |
| Max. Negotiated Rate |
$3,135.65 |
| Rate for Payer: Cash Price |
$1,660.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,475.60
|
| Rate for Payer: Galaxy Health WC |
$3,135.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,213.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,460.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,405.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$885.36
|
| Rate for Payer: Multiplan Commercial |
$2,951.20
|
| Rate for Payer: Networks By Design Commercial |
$2,397.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,135.65
|
|
|
HC CERULOPLASMIN
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900910839
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$89.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.97
|
| Rate for Payer: BCBS Transplant Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$20.03
|
| Rate for Payer: Blue Shield of California EPN |
$15.87
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Media |
$10.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.74
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$17.61
|
| Rate for Payer: IEHP Medi-Cal |
$17.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$17.40
|
| Rate for Payer: IEHP Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.70
|
| Rate for Payer: United Healthcare All Other HMO |
$8.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
OP
|
$385.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: BCBS Transplant Transplant |
$231.00
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA PPO |
$284.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Media |
$248.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.97
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$288.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.31
|
| Rate for Payer: Heritage Provider Network Transplant |
$408.31
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.62
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$231.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.50
|
| Rate for Payer: United Healthcare All Other HMO |
$192.50
|
| Rate for Payer: United Healthcare HMO Rider |
$192.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$192.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
IP
|
$385.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$327.25 |
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
OP
|
$385.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.38
|
| Rate for Payer: BCBS Transplant Transplant |
$231.00
|
| Rate for Payer: Blue Shield of California Commercial |
$283.74
|
| Rate for Payer: Blue Shield of California EPN |
$224.84
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA HMO |
$246.40
|
| Rate for Payer: Cigna of CA PPO |
$284.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Media |
$248.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.97
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$288.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.31
|
| Rate for Payer: Heritage Provider Network Transplant |
$408.31
|
| Rate for Payer: IEHP Medi-Cal |
$403.33
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$403.33
|
| Rate for Payer: IEHP Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.62
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$231.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.50
|
| Rate for Payer: United Healthcare All Other HMO |
$192.50
|
| Rate for Payer: United Healthcare HMO Rider |
$192.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$192.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
IP
|
$385.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$327.25 |
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
IP
|
$1,638.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$393.12 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$655.20
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.12
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
OP
|
$1,638.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$393.12 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$982.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,207.21
|
| Rate for Payer: Blue Shield of California EPN |
$956.59
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cigna of CA HMO |
$1,048.32
|
| Rate for Payer: Cigna of CA PPO |
$1,212.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,228.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: IEHP Medi-Cal |
$649.33
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$649.33
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$982.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$982.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$982.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$819.00
|
| Rate for Payer: United Healthcare All Other HMO |
$819.00
|
| Rate for Payer: United Healthcare HMO Rider |
$819.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$819.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
IP
|
$1,638.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$393.12 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$655.20
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.12
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
OP
|
$1,638.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$393.12 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$982.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,207.21
|
| Rate for Payer: Blue Shield of California EPN |
$956.59
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cigna of CA HMO |
$1,048.32
|
| Rate for Payer: Cigna of CA PPO |
$1,212.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,228.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: IEHP Medi-Cal |
$649.33
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$649.33
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$982.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$982.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$982.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC CERVICAL DISCOGRAPHY, 1 LEV
|
Facility
OP
|
$624.00
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
909000184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.76 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$530.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$343.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$343.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$374.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna of CA PPO |
$461.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$530.40
|
| Rate for Payer: Dignity Health Media |
$530.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$530.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$249.60
|
| Rate for Payer: Galaxy Health WC |
$530.40
|
| Rate for Payer: Global Benefits Group Commercial |
$374.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$416.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.76
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: Networks By Design Commercial |
$405.60
|
| Rate for Payer: Prime Health Services Commercial |
$530.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$374.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$374.40
|
| 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 |
$530.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$530.40
|
| Rate for Payer: Vantage Medical Group Senior |
$530.40
|
|
|
HC CERVICAL DISCOGRAPHY, 1 LEV
|
Facility
IP
|
$624.00
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
909000184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.76 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.60
|
| Rate for Payer: Galaxy Health WC |
$530.40
|
| Rate for Payer: Global Benefits Group Commercial |
$374.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$416.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.76
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: Networks By Design Commercial |
$405.60
|
| Rate for Payer: Prime Health Services Commercial |
$530.40
|
|
|
HC CERVICAL PUNCTURE (FLUORO)
|
Facility
IP
|
$6,880.00
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
909000197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,651.20 |
| Max. Negotiated Rate |
$5,848.00 |
| Rate for Payer: Cash Price |
$3,096.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,752.00
|
| Rate for Payer: Galaxy Health WC |
$5,848.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,128.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,588.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,621.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,651.20
|
| Rate for Payer: Multiplan Commercial |
$5,504.00
|
| Rate for Payer: Networks By Design Commercial |
$4,472.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,848.00
|
|
|
HC CERVICAL PUNCTURE (FLUORO)
|
Facility
OP
|
$6,880.00
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
909000197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$5,848.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,128.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$3,096.00
|
| Rate for Payer: Cash Price |
$3,096.00
|
| Rate for Payer: Cigna of CA PPO |
$5,091.20
|
| 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 |
$5,848.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,128.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,160.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: IEHP Medi-Cal |
$599.50
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$599.50
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,588.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,651.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$5,504.00
|
| Rate for Payer: Networks By Design Commercial |
$4,472.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,848.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,128.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,128.00
|
| 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 CERVICAL PUNCTURE FOR MYELO
|
Facility
OP
|
$1,561.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
909000179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$268.79 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$936.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$702.45
|
| Rate for Payer: Cash Price |
$702.45
|
| Rate for Payer: Cigna of CA PPO |
$1,155.14
|
| 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 |
$1,326.85
|
| Rate for Payer: Global Benefits Group Commercial |
$936.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,170.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: IEHP Medi-Cal |
$599.50
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$599.50
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,248.80
|
| Rate for Payer: Networks By Design Commercial |
$1,014.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,326.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$936.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$936.60
|
| 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 Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC CERVICAL PUNCTURE FOR MYELO
|
Facility
IP
|
$1,561.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
909000179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$374.64 |
| Max. Negotiated Rate |
$1,326.85 |
| Rate for Payer: Cash Price |
$702.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.40
|
| Rate for Payer: Galaxy Health WC |
$1,326.85
|
| Rate for Payer: Global Benefits Group Commercial |
$936.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.64
|
| Rate for Payer: Multiplan Commercial |
$1,248.80
|
| Rate for Payer: Networks By Design Commercial |
$1,014.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,326.85
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
IP
|
$1,214.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$291.36 |
| Max. Negotiated Rate |
$1,031.90 |
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.60
|
| Rate for Payer: Galaxy Health WC |
$1,031.90
|
| Rate for Payer: Global Benefits Group Commercial |
$728.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.36
|
| Rate for Payer: Multiplan Commercial |
$971.20
|
| Rate for Payer: Networks By Design Commercial |
$789.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.90
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
OP
|
$1,214.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.50 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$667.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$667.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$728.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cigna of CA PPO |
$898.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.90
|
| Rate for Payer: Dignity Health Media |
$1,031.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,031.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$485.60
|
| Rate for Payer: Galaxy Health WC |
$1,031.90
|
| Rate for Payer: Global Benefits Group Commercial |
$728.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$910.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.36
|
| Rate for Payer: Multiplan Commercial |
$971.20
|
| Rate for Payer: Networks By Design Commercial |
$789.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$728.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$728.40
|
| 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 |
$1,031.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,031.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,031.90
|
|
|
HC CHANGE EXT/INT URETER STENT
|
Facility
IP
|
$6,495.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,558.80 |
| Max. Negotiated Rate |
$5,520.75 |
| Rate for Payer: Cash Price |
$2,922.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,598.00
|
| Rate for Payer: Galaxy Health WC |
$5,520.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,897.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,332.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,474.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,558.80
|
| Rate for Payer: Multiplan Commercial |
$5,196.00
|
| Rate for Payer: Networks By Design Commercial |
$4,221.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,520.75
|
|
