|
HC CELL MORPHOLOGY (VISUAL)
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
900910073
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC CELL MORPHOLOGY VISUAL INDIVIDUAL
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
900912021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC CELL MORPHOLOGY VISUAL INDIVIDUAL
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
900912021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$33.98 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.98
|
| Rate for Payer: Blue Shield of California Commercial |
$16.06
|
| Rate for Payer: Blue Shield of California EPN |
$10.61
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$3.80
|
|
|
HC CELLULAR THERAPY RECEIPT AND HANDLING
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.92
|
| Rate for Payer: Blue Shield of California Commercial |
$81.62
|
| Rate for Payer: Blue Shield of California EPN |
$53.92
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC CELLULAR THERAPY RECEIPT AND HANDLING
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC CEMENTOPLASTY
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909080999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$107.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.16
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cigna of CA HMO |
$343.04
|
| Rate for Payer: Cigna of CA PPO |
$396.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$455.60
|
| Rate for Payer: Global Benefits Group Commercial |
$321.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$357.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$428.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$348.40
|
| Rate for Payer: Prime Health Services Commercial |
$455.60
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CEMENTOPLASTY
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909080999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$455.60 |
| Rate for Payer: Adventist Health Commercial |
$107.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.40
|
| Rate for Payer: EPIC Health Plan Senior |
$214.40
|
| Rate for Payer: Galaxy Health WC |
$455.60
|
| Rate for Payer: Global Benefits Group Commercial |
$321.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$357.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$331.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.64
|
| Rate for Payer: Multiplan Commercial |
$428.80
|
| Rate for Payer: Networks By Design Commercial |
$348.40
|
| Rate for Payer: Prime Health Services Commercial |
$455.60
|
|
|
HC CENTRL MOTR STDY UPPER & LOWER
|
Facility
|
IP
|
$1,854.00
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
900600322
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$370.80 |
| Max. Negotiated Rate |
$1,575.90 |
| Rate for Payer: Adventist Health Commercial |
$370.80
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.60
|
| Rate for Payer: EPIC Health Plan Senior |
$741.60
|
| Rate for Payer: Galaxy Health WC |
$1,575.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,112.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,236.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$706.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,147.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.96
|
| Rate for Payer: Multiplan Commercial |
$1,483.20
|
| Rate for Payer: Networks By Design Commercial |
$1,205.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.90
|
|
|
HC CENTRL MOTR STDY UPPER & LOWER
|
Facility
|
OP
|
$1,854.00
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
900600322
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$370.80 |
| Max. Negotiated Rate |
$2,120.03 |
| Rate for Payer: Adventist Health Commercial |
$370.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,216.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,292.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,138.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,134.65
|
| Rate for Payer: Blue Shield of California EPN |
$749.02
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cigna of CA HMO |
$1,186.56
|
| Rate for Payer: Cigna of CA PPO |
$1,371.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,421.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,292.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,745.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,292.70
|
| Rate for Payer: Galaxy Health WC |
$1,575.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,112.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,120.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$698.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,292.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,236.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$789.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,292.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,628.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,732.22
|
| Rate for Payer: Multiplan Commercial |
$1,483.20
|
| Rate for Payer: Networks By Design Commercial |
$1,205.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,112.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,112.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,292.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1,292.70
|
|
|
HC CENTROMERE AB
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913527
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$42.82
|
| Rate for Payer: Blue Shield of California EPN |
$28.29
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| 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 |
$15.36
|
| 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 |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC CENTROMERE AB
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913527
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC CEREBRAL BLOOD FLOW
|
Facility
|
OP
|
$3,136.00
|
|
|
Service Code
|
CPT 78610
|
| Hospital Charge Code |
909301412
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$67.57 |
| Max. Negotiated Rate |
$2,665.60 |
| Rate for Payer: Adventist Health Commercial |
$627.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,056.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,925.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,919.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,266.94
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Cigna of CA HMO |
$2,007.04
|
| Rate for Payer: Cigna of CA PPO |
$2,320.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$2,665.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,881.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,091.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$2,508.80
|
| Rate for Payer: Networks By Design Commercial |
$2,038.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,665.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,881.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,881.60
|
| 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: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC CEREBRAL BLOOD FLOW
|
Facility
|
IP
|
$3,136.00
|
|
|
Service Code
|
CPT 78610
|
| Hospital Charge Code |
909301412
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$627.20 |
| Max. Negotiated Rate |
$2,665.60 |
| Rate for Payer: Adventist Health Commercial |
$627.20
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,254.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,254.40
|
| Rate for Payer: Galaxy Health WC |
$2,665.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,881.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,091.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,194.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,941.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.64
|
| Rate for Payer: Multiplan Commercial |
$2,508.80
|
| Rate for Payer: Networks By Design Commercial |
$2,038.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,665.60
|
|
|
HC CERULOPLASMIN
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900910839
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.72
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
|
|
HC CERULOPLASMIN
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900910839
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$106.06 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.06
|
| Rate for Payer: Blue Shield of California Commercial |
$54.86
|
| Rate for Payer: Blue Shield of California EPN |
$36.24
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Senior |
$10.74
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| 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 |
$19.68
|
| 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 |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| 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: Upland Medical Group Pediatric |
$10.74
|
| 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
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$263.50 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$191.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: Networks By Design Commercial |
$201.50
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$263.50 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$191.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: Networks By Design Commercial |
$201.50
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna of CA HMO |
$198.40
|
| Rate for Payer: Cigna of CA PPO |
$229.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$201.50
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.00
|
| Rate for Payer: United Healthcare All Other HMO |
$155.00
|
| Rate for Payer: United Healthcare HMO Rider |
$155.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.37
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna of CA HMO |
$198.40
|
| Rate for Payer: Cigna of CA PPO |
$229.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: Networks By Design Commercial |
$201.50
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.00
|
| Rate for Payer: United Healthcare All Other HMO |
$155.00
|
| Rate for Payer: United Healthcare HMO Rider |
$155.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
|
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$320.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cigna of CA HMO |
$1,024.64
|
| Rate for Payer: Cigna of CA PPO |
$1,184.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$1,360.85
|
| Rate for Payer: Global Benefits Group Commercial |
$960.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$1,280.80
|
| Rate for Payer: Networks By Design Commercial |
$1,040.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$960.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$960.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
|
IP
|
$1,601.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$320.20 |
| Max. Negotiated Rate |
$1,360.85 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.40
|
| Rate for Payer: EPIC Health Plan Senior |
$640.40
|
| Rate for Payer: Galaxy Health WC |
$1,360.85
|
| Rate for Payer: Global Benefits Group Commercial |
$960.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$991.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.24
|
| Rate for Payer: Multiplan Commercial |
$1,280.80
|
| Rate for Payer: Networks By Design Commercial |
$1,040.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.85
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
|
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$320.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cigna of CA HMO |
$1,024.64
|
| Rate for Payer: Cigna of CA PPO |
$1,184.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$1,360.85
|
| Rate for Payer: Global Benefits Group Commercial |
$960.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$1,280.80
|
| Rate for Payer: Networks By Design Commercial |
$1,040.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$960.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$960.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$800.50
|
| Rate for Payer: United Healthcare All Other HMO |
$800.50
|
| Rate for Payer: United Healthcare HMO Rider |
$800.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$800.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
|
IP
|
$1,601.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$320.20 |
| Max. Negotiated Rate |
$1,360.85 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.40
|
| Rate for Payer: EPIC Health Plan Senior |
$640.40
|
| Rate for Payer: Galaxy Health WC |
$1,360.85
|
| Rate for Payer: Global Benefits Group Commercial |
$960.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$991.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.24
|
| Rate for Payer: Multiplan Commercial |
$1,280.80
|
| Rate for Payer: Networks By Design Commercial |
$1,040.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.85
|
|
|
HC CERVICAL DISCOGRAPHY, 1 LEV
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
909000184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$450.50 |
| Rate for Payer: Adventist Health Commercial |
$106.00
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.00
|
| Rate for Payer: EPIC Health Plan Senior |
$212.00
|
| Rate for Payer: Galaxy Health WC |
$450.50
|
| Rate for Payer: Global Benefits Group Commercial |
$318.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$328.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.20
|
| Rate for Payer: Multiplan Commercial |
$424.00
|
| Rate for Payer: Networks By Design Commercial |
$344.50
|
| Rate for Payer: Prime Health Services Commercial |
$450.50
|
|
|
HC CERVICAL DISCOGRAPHY, 1 LEV
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
909000184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$106.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$291.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$397.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna of CA HMO |
$339.20
|
| Rate for Payer: Cigna of CA PPO |
$392.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$450.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$450.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$450.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.00
|
| Rate for Payer: EPIC Health Plan Senior |
$212.00
|
| Rate for Payer: Galaxy Health WC |
$450.50
|
| Rate for Payer: Global Benefits Group Commercial |
$318.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$328.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.00
|
| Rate for Payer: Multiplan Commercial |
$424.00
|
| Rate for Payer: Networks By Design Commercial |
$344.50
|
| Rate for Payer: Prime Health Services Commercial |
$450.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$318.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$450.50
|
| Rate for Payer: Vantage Medical Group Senior |
$450.50
|
|
