|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.27
|
| 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
|
$153.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900910839
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| 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 Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.83
|
| Rate for Payer: Blue Shield of California Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$106.64
|
| Rate for Payer: Blue Shield of California Commercial |
$57.15
|
| Rate for Payer: Blue Shield of California Commercial |
$70.53
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA HMO |
$97.92
|
| Rate for Payer: Cigna of CA PPO |
$113.22
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.72
|
| Rate for Payer: EPIC Health Plan Senior |
$11.81
|
| Rate for Payer: EPIC Health Plan Senior |
$11.81
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.04
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.72
|
| 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 Medi-Cal |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.80
|
| 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 Commercial |
$8.70
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.74
|
| 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 Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
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 |
$429.05 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.93
|
| 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 |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$217.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.05
|
| Rate for Payer: EPIC Health Plan Senior |
$286.03
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$426.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$196.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$327.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$348.44
|
| 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 |
$260.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$217.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$196.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.90
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$217.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$196.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.90
|
| 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 |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| 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 |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$217.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.05
|
| Rate for Payer: EPIC Health Plan Senior |
$286.03
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$426.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$196.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$279.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$327.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$348.44
|
| 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 |
$260.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,016.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$944.59
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,016.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$944.59
|
| 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
|
720
|
| Min. Negotiated Rate |
$307.91 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$307.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: 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 |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| 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/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,016.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$581.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| 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 |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
|
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$307.91 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$307.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| 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/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,016.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$581.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| 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 |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$106.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$371.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$336.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$312.70
|
| 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 |
$265.00
|
| 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
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$371.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$336.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$312.70
|
| 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 PUNCTURE (FLUORO)
|
Facility
|
IP
|
$6,725.00
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
909000197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,345.00 |
| Max. Negotiated Rate |
$5,716.25 |
| Rate for Payer: Adventist Health Commercial |
$1,345.00
|
| Rate for Payer: Cash Price |
$3,026.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,707.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,690.00
|
| Rate for Payer: Galaxy Health WC |
$5,716.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,270.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,967.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.00
|
| Rate for Payer: Multiplan Commercial |
$5,380.00
|
| Rate for Payer: Networks By Design Commercial |
$4,371.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,716.25
|
|
|
HC CERVICAL PUNCTURE (FLUORO)
|
Facility
|
OP
|
$6,725.00
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
909000197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,345.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$3,026.25
|
| Rate for Payer: Cash Price |
$3,026.25
|
| Rate for Payer: Cash Price |
$3,026.25
|
| Rate for Payer: Cigna of CA HMO |
$4,304.00
|
| Rate for Payer: Cigna of CA PPO |
$4,976.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,707.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$5,716.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,270.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$5,380.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$4,371.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,716.25
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,035.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,362.50
|
| 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 |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC CERVICAL PUNCTURE FOR MYELO
|
Facility
|
IP
|
$1,526.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
909000179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$305.20 |
| Max. Negotiated Rate |
$1,297.10 |
| Rate for Payer: Adventist Health Commercial |
$305.20
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,068.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.40
|
| Rate for Payer: EPIC Health Plan Senior |
$610.40
|
| Rate for Payer: Galaxy Health WC |
$1,297.10
|
| Rate for Payer: Global Benefits Group Commercial |
$915.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$969.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$900.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.24
|
| Rate for Payer: Multiplan Commercial |
$1,220.80
|
| Rate for Payer: Networks By Design Commercial |
$991.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,297.10
|
|
|
HC CERVICAL PUNCTURE FOR MYELO
|
Facility
|
OP
|
$1,526.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
909000179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$237.67 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$305.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna of CA HMO |
$976.64
|
| Rate for Payer: Cigna of CA PPO |
$1,129.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,068.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,297.10
|
| Rate for Payer: Global Benefits Group Commercial |
$915.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$237.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$969.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$268.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,220.80
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$991.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,297.10
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$915.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.00
|
| 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 |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC CERVICAL/VAGINAL CANCER SCREEN
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
902890216
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC CERVICAL/VAGINAL CANCER SCREEN
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
902890216
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.96
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.59
|
| Rate for Payer: EPIC Health Plan Senior |
$143.73
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.00
|
| Rate for Payer: United Healthcare All Other HMO |
$141.00
|
| Rate for Payer: United Healthcare HMO Rider |
$141.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$135.73 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$196.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$539.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cigna of CA HMO |
$627.20
|
| Rate for Payer: Cigna of CA PPO |
$725.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$833.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$833.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$686.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.00
|
| Rate for Payer: EPIC Health Plan Senior |
$392.00
|
| Rate for Payer: Galaxy Health WC |
$833.00
|
| Rate for Payer: Global Benefits Group Commercial |
$588.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$622.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$578.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$686.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$686.00
|
| Rate for Payer: Multiplan Commercial |
$784.00
|
| Rate for Payer: Networks By Design Commercial |
$637.00
|
| Rate for Payer: Prime Health Services Commercial |
$833.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$588.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$490.00
|
| 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 |
$833.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$833.00
|
| Rate for Payer: Vantage Medical Group Senior |
$833.00
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$833.00 |
| Rate for Payer: Adventist Health Commercial |
$196.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$686.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.00
|
| Rate for Payer: EPIC Health Plan Senior |
$392.00
|
| Rate for Payer: Galaxy Health WC |
$833.00
|
| Rate for Payer: Global Benefits Group Commercial |
$588.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$622.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$578.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$784.00
|
| Rate for Payer: Networks By Design Commercial |
$637.00
|
| Rate for Payer: Prime Health Services Commercial |
$833.00
|
|
|
HC CESAREAN DELIVERY ONLY
|
Facility
|
OP
|
$3,725.00
|
|
|
Service Code
|
CPT 59514
|
| Hospital Charge Code |
900501514
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$11,927.00 |
| Rate for Payer: Adventist Health Commercial |
$745.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,673.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,166.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,048.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,793.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,927.00
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cigna of CA HMO |
$2,384.00
|
| Rate for Payer: Cigna of CA PPO |
$2,756.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,166.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,166.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,166.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,607.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,490.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,490.00
|
| Rate for Payer: Galaxy Health WC |
$3,166.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,235.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$915.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,365.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,034.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,197.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,607.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,607.50
|
| Rate for Payer: Multiplan Commercial |
$2,980.00
|
| Rate for Payer: Networks By Design Commercial |
$2,421.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,166.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,235.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,235.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$3,166.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,166.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,166.25
|
|
|
HC CESAREAN DELIVERY ONLY
|
Facility
|
IP
|
$3,725.00
|
|
|
Service Code
|
CPT 59514
|
| Hospital Charge Code |
900501514
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$3,166.25 |
| Rate for Payer: Adventist Health Commercial |
$745.00
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,607.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,490.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,490.00
|
| Rate for Payer: Galaxy Health WC |
$3,166.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,235.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,365.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,197.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.00
|
| Rate for Payer: Multiplan Commercial |
$2,980.00
|
| Rate for Payer: Networks By Design Commercial |
$2,421.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,166.25
|
|
|
HC C GLABRATA AND C KRUSEI NAT
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87481 59
|
| Hospital Charge Code |
900912494
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC C GLABRATA AND C KRUSEI NAT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87481 59
|
| Hospital Charge Code |
900912494
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$52.97
|
| Rate for Payer: Blue Shield of California Commercial |
$73.88
|
| Rate for Payer: Blue Shield of California Commercial |
$48.87
|
| Rate for Payer: Blue Shield of California Commercial |
$35.04
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
|
|
HC CHANGE EXT/INT URETER STENT
|
Facility
|
IP
|
$6,349.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,269.80 |
| Max. Negotiated Rate |
$5,396.65 |
| Rate for Payer: Adventist Health Commercial |
$1,269.80
|
| Rate for Payer: Cash Price |
$2,857.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,444.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,539.60
|
| Rate for Payer: Galaxy Health WC |
$5,396.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,809.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,031.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,745.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,523.76
|
| Rate for Payer: Multiplan Commercial |
$5,079.20
|
| Rate for Payer: Networks By Design Commercial |
$4,126.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,396.65
|
|
