|
HC LIVER BIOPSY W OTHER PROC
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
909000141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$92.66 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$534.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$345.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$345.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$377.40
|
| 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 |
$283.05
|
| Rate for Payer: Cash Price |
$283.05
|
| Rate for Payer: Cash Price |
$283.05
|
| Rate for Payer: Cigna of CA PPO |
$465.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$534.65
|
| Rate for Payer: Dignity Health Media |
$534.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$534.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$251.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$251.60
|
| Rate for Payer: Galaxy Health WC |
$534.65
|
| Rate for Payer: Global Benefits Group Commercial |
$377.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$471.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$419.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.96
|
| Rate for Payer: Multiplan Commercial |
$503.20
|
| Rate for Payer: Networks By Design Commercial |
$408.85
|
| Rate for Payer: Prime Health Services Commercial |
$534.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$377.40
|
| 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 |
$534.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$534.65
|
| Rate for Payer: Vantage Medical Group Senior |
$534.65
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
OP
|
$2,121.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$164.39 |
| Max. Negotiated Rate |
$1,802.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,065.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,263.69
|
| Rate for Payer: Blue Distinction Transplant |
$1,272.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,253.51
|
| Rate for Payer: Blue Shield of California EPN |
$994.75
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cigna of CA HMO |
$1,357.44
|
| Rate for Payer: Cigna of CA PPO |
$1,569.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,802.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,590.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: Networks By Design Commercial |
$1,378.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,272.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,272.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
IP
|
$2,121.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$509.04 |
| Max. Negotiated Rate |
$1,802.85 |
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.40
|
| Rate for Payer: Galaxy Health WC |
$1,802.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$808.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.04
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: Networks By Design Commercial |
$1,378.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.85
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
IP
|
$2,803.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$672.72 |
| Max. Negotiated Rate |
$2,382.55 |
| Rate for Payer: Cash Price |
$1,261.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,121.20
|
| Rate for Payer: Galaxy Health WC |
$2,382.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,681.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,869.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,067.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$672.72
|
| Rate for Payer: Multiplan Commercial |
$2,242.40
|
| Rate for Payer: Networks By Design Commercial |
$1,821.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,382.55
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
OP
|
$2,803.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$216.22 |
| Max. Negotiated Rate |
$2,382.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$652.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,670.03
|
| Rate for Payer: Blue Distinction Transplant |
$1,681.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,656.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,314.61
|
| Rate for Payer: Cash Price |
$1,261.35
|
| Rate for Payer: Cash Price |
$1,261.35
|
| Rate for Payer: Cigna of CA HMO |
$1,793.92
|
| Rate for Payer: Cigna of CA PPO |
$2,074.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$2,382.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,681.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,102.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,869.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$672.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$2,242.40
|
| Rate for Payer: Networks By Design Commercial |
$1,821.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,382.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,681.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,681.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC LMA AIRWARY
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$98.16 |
| Max. Negotiated Rate |
$347.65 |
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.60
|
| Rate for Payer: Galaxy Health WC |
$347.65
|
| Rate for Payer: Global Benefits Group Commercial |
$245.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.16
|
| Rate for Payer: Multiplan Commercial |
$327.20
|
| Rate for Payer: Networks By Design Commercial |
$265.85
|
| Rate for Payer: Prime Health Services Commercial |
$347.65
|
|
|
HC LMA AIRWARY
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$98.16 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$268.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.68
|
| Rate for Payer: Blue Distinction Transplant |
$245.40
|
| Rate for Payer: Blue Shield of California Commercial |
$241.72
|
| Rate for Payer: Blue Shield of California EPN |
$191.82
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cigna of CA HMO |
$261.76
|
| Rate for Payer: Cigna of CA PPO |
$302.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$347.65
|
| Rate for Payer: Global Benefits Group Commercial |
$245.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$306.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$316.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$327.20
|
| Rate for Payer: Networks By Design Commercial |
$265.85
|
| Rate for Payer: Prime Health Services Commercial |
$347.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$245.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$245.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC LOCALIZATION OF TUMOR PLANAR
|
Facility
|
IP
|
$1,178.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
909301253
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.72 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.20
|
| Rate for Payer: Galaxy Health WC |
$1,001.30
|
| Rate for Payer: Global Benefits Group Commercial |
$706.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.72
|
| Rate for Payer: Multiplan Commercial |
$942.40
|
| Rate for Payer: Networks By Design Commercial |
$765.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.30
|
|
|
HC LOCALIZATION OF TUMOR PLANAR
|
Facility
|
OP
|
$1,178.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
909301253
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$251.56 |
| Max. Negotiated Rate |
$1,358.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,358.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$701.85
|
| Rate for Payer: Blue Distinction Transplant |
$706.80
|
| Rate for Payer: Blue Shield of California Commercial |
$696.20
|
| Rate for Payer: Blue Shield of California EPN |
$552.48
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cigna of CA HMO |
$753.92
|
| Rate for Payer: Cigna of CA PPO |
$871.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,001.30
|
| Rate for Payer: Global Benefits Group Commercial |
$706.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$883.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$942.40
|
| Rate for Payer: Networks By Design Commercial |
$765.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$706.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$706.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,260.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,260.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,260.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,260.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC LOOPOGRAM (ILEAL CONDUIT)
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
909000207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$386.75 |
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$364.00
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC LOOPOGRAM (ILEAL CONDUIT)
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
909000207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$273.00
|
| 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 |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: Dignity Health Media |
$386.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$341.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$364.00
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| 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 |
$386.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC LOW FREQ NON-CONTACT/THRMAL US
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
CPT 97610
|
| Hospital Charge Code |
900803112
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$108.72 |
| Max. Negotiated Rate |
$385.05 |
| Rate for Payer: Cash Price |
$203.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.20
|
| Rate for Payer: Galaxy Health WC |
$385.05
|
| Rate for Payer: Global Benefits Group Commercial |
$271.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$302.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.72
|
| Rate for Payer: Multiplan Commercial |
$362.40
|
| Rate for Payer: Networks By Design Commercial |
$294.45
|
| Rate for Payer: Prime Health Services Commercial |
$385.05
|
|
|
HC LOW FREQ NON-CONTACT/THRMAL US
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
CPT 97610
|
| Hospital Charge Code |
900803112
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$108.72 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$139.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$269.90
|
| Rate for Payer: Blue Distinction Transplant |
$271.80
|
| Rate for Payer: Blue Shield of California Commercial |
$333.86
|
| Rate for Payer: Blue Shield of California EPN |
$264.55
|
| Rate for Payer: Cash Price |
$203.85
|
| Rate for Payer: Cash Price |
$203.85
|
| Rate for Payer: Cash Price |
$203.85
|
| Rate for Payer: Cigna of CA HMO |
$289.92
|
| Rate for Payer: Cigna of CA PPO |
$335.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$385.05
|
| Rate for Payer: Global Benefits Group Commercial |
$271.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$339.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$405.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$405.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$302.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$362.40
|
| Rate for Payer: Networks By Design Commercial |
$294.45
|
| Rate for Payer: Prime Health Services Commercial |
$385.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC LOW MIGRAT STAGE IV CONF & ID
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$562.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.21
|
| Rate for Payer: Blue Distinction Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$145.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.20
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Media |
$62.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$100.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC LRNGSCPY, FLXBL W BX OR BXS
|
Facility
|
IP
|
$4,359.00
|
|
|
Service Code
|
CPT 31576
|
| Hospital Charge Code |
900500576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,046.16 |
| Max. Negotiated Rate |
$3,705.15 |
| Rate for Payer: Cash Price |
$1,961.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,743.60
|
| Rate for Payer: Galaxy Health WC |
$3,705.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,615.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,907.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,660.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,046.16
|
| Rate for Payer: Multiplan Commercial |
$3,487.20
|
| Rate for Payer: Networks By Design Commercial |
$2,833.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,705.15
|
|
|
HC LRNGSCPY, FLXBL W BX OR BXS
|
Facility
|
OP
|
$4,359.00
|
|
|
Service Code
|
CPT 31576
|
| Hospital Charge Code |
900500576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,615.40
|
| Rate for Payer: Cash Price |
$1,961.55
|
| Rate for Payer: Cash Price |
$1,961.55
|
| Rate for Payer: Cash Price |
$1,961.55
|
| Rate for Payer: Cigna of CA PPO |
$3,225.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Galaxy Health WC |
$3,705.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,615.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,269.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,477.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,477.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,907.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,046.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Multiplan Commercial |
$3,487.20
|
| Rate for Payer: Networks By Design Commercial |
$2,833.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,705.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,615.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,179.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,179.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,179.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,179.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC LUMBAR DISCOGRAPHY, 1 LEVEL
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
909000183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$193.44 |
| Max. Negotiated Rate |
$685.10 |
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.44
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: Networks By Design Commercial |
$523.90
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
|
|
HC LUMBAR DISCOGRAPHY, 1 LEVEL
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
909000183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$193.44 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$443.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$483.60
|
| 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 |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cigna of CA PPO |
$596.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.10
|
| Rate for Payer: Dignity Health Media |
$685.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$604.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.44
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: Networks By Design Commercial |
$523.90
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.60
|
| 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 |
$685.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.10
|
| Rate for Payer: Vantage Medical Group Senior |
$685.10
|
|
|
HC LUMBAR PUNCTURE FOR MYELOGR
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
909000181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.44 |
| Max. Negotiated Rate |
$600.10 |
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.44
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: Networks By Design Commercial |
$458.90
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
|
|
HC LUMBAR PUNCTURE FOR MYELOGR
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
909000181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.36 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$600.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$388.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$388.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$423.60
|
| 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 |
$317.70
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cigna of CA PPO |
$522.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$600.10
|
| Rate for Payer: Dignity Health Media |
$600.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$600.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$529.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.44
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: Networks By Design Commercial |
$458.90
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.60
|
| 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 |
$600.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$600.10
|
| Rate for Payer: Vantage Medical Group Senior |
$600.10
|
|
|
HC LUMBAR/SACRAL FACET INJ 3RD EA
|
Facility
|
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
909020044
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$351.84 |
| Max. Negotiated Rate |
$1,246.10 |
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.40
|
| Rate for Payer: Galaxy Health WC |
$1,246.10
|
| Rate for Payer: Global Benefits Group Commercial |
$879.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$1,172.80
|
| Rate for Payer: Networks By Design Commercial |
$952.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,246.10
|
|
|
HC LUMBAR/SACRAL FACET INJ 3RD EA
|
Facility
|
OP
|
$1,466.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
909020044
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.77 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,246.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$806.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$879.60
|
| 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 |
$659.70
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cigna of CA PPO |
$1,084.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,246.10
|
| Rate for Payer: Dignity Health Media |
$1,246.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,246.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$586.40
|
| Rate for Payer: Galaxy Health WC |
$1,246.10
|
| Rate for Payer: Global Benefits Group Commercial |
$879.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,099.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$1,172.80
|
| Rate for Payer: Networks By Design Commercial |
$952.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,246.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$879.60
|
| 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 |
$1,246.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,246.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,246.10
|
|
|
HC LUMBAR/SACRAL FACET INJECT/ADD
|
Facility
|
OP
|
$2,675.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
909000186
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,273.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,471.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,471.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,605.00
|
| 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 |
$1,203.75
|
| Rate for Payer: Cash Price |
$1,203.75
|
| Rate for Payer: Cigna of CA PPO |
$1,979.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,273.75
|
| Rate for Payer: Dignity Health Media |
$2,273.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,273.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,070.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,070.00
|
| Rate for Payer: Galaxy Health WC |
$2,273.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,605.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,006.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,784.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.00
|
| Rate for Payer: Multiplan Commercial |
$2,140.00
|
| Rate for Payer: Networks By Design Commercial |
$1,738.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,273.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,605.00
|
| 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 |
$2,273.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,273.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,273.75
|
|
|
HC LUMBAR/SACRAL FACET INJECT/ADD
|
Facility
|
IP
|
$2,675.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
909000186
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$642.00 |
| Max. Negotiated Rate |
$2,273.75 |
| Rate for Payer: Cash Price |
$1,203.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,070.00
|
| Rate for Payer: Galaxy Health WC |
$2,273.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,605.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,784.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,019.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.00
|
| Rate for Payer: Multiplan Commercial |
$2,140.00
|
| Rate for Payer: Networks By Design Commercial |
$1,738.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,273.75
|
|
|
HC LUMBAR/SACRAL FACET INJECT/INT
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
909000185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$721.92 |
| Max. Negotiated Rate |
$2,556.80 |
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,203.20
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,146.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.92
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,556.80
|
|
