|
HC LUMBAR/SACRAL FACET INJECT/INT
|
Facility
|
OP
|
$3,008.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
909000185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$274.46 |
| 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 |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,804.80
|
| 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 |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cigna of CA PPO |
$2,225.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,556.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,804.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,256.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,867.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,844.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,804.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC LUMBAR SPINE AP AND LATERAL
|
Facility
|
OP
|
$1,004.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.55 |
| Max. Negotiated Rate |
$853.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$185.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.94
|
| Rate for Payer: Blue Distinction Transplant |
$602.40
|
| Rate for Payer: Blue Shield of California Commercial |
$593.36
|
| Rate for Payer: Blue Shield of California EPN |
$470.88
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna of CA HMO |
$642.56
|
| Rate for Payer: Cigna of CA PPO |
$742.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$753.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$803.20
|
| Rate for Payer: Networks By Design Commercial |
$652.60
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$602.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$602.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC LUMBAR SPINE AP AND LATERAL
|
Facility
|
IP
|
$1,004.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.96 |
| Max. Negotiated Rate |
$853.40 |
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.96
|
| Rate for Payer: Multiplan Commercial |
$803.20
|
| Rate for Payer: Networks By Design Commercial |
$652.60
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
|
|
HC LUMBAR SPINE LIMITED
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$169.15 |
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.60
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.76
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Networks By Design Commercial |
$129.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
|
|
HC LUMBAR SPINE LIMITED
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$225.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$185.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.94
|
| Rate for Payer: Blue Distinction Transplant |
$119.40
|
| Rate for Payer: Blue Shield of California Commercial |
$117.61
|
| Rate for Payer: Blue Shield of California EPN |
$93.33
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Cigna of CA HMO |
$127.36
|
| Rate for Payer: Cigna of CA PPO |
$147.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$149.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Networks By Design Commercial |
$129.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC LUM/SAC ABL EA ADD LEVEL
|
Facility
|
OP
|
$2,729.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909000263
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.49 |
| 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 |
$2,319.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,500.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,500.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,637.40
|
| 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 |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cigna of CA PPO |
$2,019.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,319.65
|
| Rate for Payer: Dignity Health Media |
$2,319.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,319.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,091.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,091.60
|
| Rate for Payer: Galaxy Health WC |
$2,319.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,637.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,046.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.96
|
| Rate for Payer: Multiplan Commercial |
$2,183.20
|
| Rate for Payer: Networks By Design Commercial |
$1,773.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,319.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,637.40
|
| 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 |
$2,319.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,319.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,319.65
|
|
|
HC LUM/SAC ABL EA ADD LEVEL
|
Facility
|
IP
|
$2,729.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909000263
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$654.96 |
| Max. Negotiated Rate |
$2,319.65 |
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,091.60
|
| Rate for Payer: Galaxy Health WC |
$2,319.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,637.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,039.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.96
|
| Rate for Payer: Multiplan Commercial |
$2,183.20
|
| Rate for Payer: Networks By Design Commercial |
$1,773.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,319.65
|
|
|
HC LUM SPINE BEND ONLY/4 VIEWS
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
909001318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$285.84 |
| Max. Negotiated Rate |
$1,012.35 |
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.40
|
| Rate for Payer: Galaxy Health WC |
$1,012.35
|
| Rate for Payer: Global Benefits Group Commercial |
$714.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$794.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.84
|
| Rate for Payer: Multiplan Commercial |
$952.80
|
| Rate for Payer: Networks By Design Commercial |
$774.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,012.35
|
|
|
HC LUM SPINE BEND ONLY/4 VIEWS
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
909001318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$1,012.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$254.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.98
|
| Rate for Payer: Blue Distinction Transplant |
$714.60
|
| Rate for Payer: Blue Shield of California Commercial |
$703.88
|
| Rate for Payer: Blue Shield of California EPN |
$558.58
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cigna of CA HMO |
$762.24
|
| Rate for Payer: Cigna of CA PPO |
$881.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,012.35
|
| Rate for Payer: Global Benefits Group Commercial |
$714.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$893.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$794.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$952.80
|
| Rate for Payer: Networks By Design Commercial |
$774.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,012.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$714.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$714.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC LUM SPINE COMP W/BENDING VIEWS
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
909001316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$441.60 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$736.00
|
| Rate for Payer: Galaxy Health WC |
$1,564.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,104.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,227.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$701.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.60
|
| Rate for Payer: Multiplan Commercial |
$1,472.00
|
| Rate for Payer: Networks By Design Commercial |
$1,196.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,564.00
|
|
|
HC LUM SPINE COMP W/BENDING VIEWS
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
909001316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$356.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.90
|
| Rate for Payer: Blue Distinction Transplant |
$1,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,087.44
|
| Rate for Payer: Blue Shield of California EPN |
$862.96
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna of CA HMO |
$1,177.60
|
| Rate for Payer: Cigna of CA PPO |
$1,361.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,564.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,104.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,380.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,227.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,472.00
|
| Rate for Payer: Networks By Design Commercial |
$1,196.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,564.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,104.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,104.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC LUM SPINE W/OBLIQUES
|
Facility
|
OP
|
$1,324.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
909001317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.32 |
| Max. Negotiated Rate |
$1,125.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$254.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.94
|
| Rate for Payer: Blue Distinction Transplant |
$794.40
|
| Rate for Payer: Blue Shield of California Commercial |
$782.48
|
| Rate for Payer: Blue Shield of California EPN |
$620.96
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna of CA HMO |
$847.36
|
| Rate for Payer: Cigna of CA PPO |
$979.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$993.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,059.20
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$794.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$794.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC LUM SPINE W/OBLIQUES
|
Facility
|
IP
|
$1,324.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
909001317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$317.76 |
| Max. Negotiated Rate |
$1,125.40 |
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.60
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$504.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.76
|
| Rate for Payer: Multiplan Commercial |
$1,059.20
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
|
|
HC LUNG DIFFER PERF & VENTILATION
|
Facility
|
IP
|
$5,292.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
909301402
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,270.08 |
| Max. Negotiated Rate |
$4,498.20 |
| Rate for Payer: Cash Price |
$2,381.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,116.80
|
| Rate for Payer: Galaxy Health WC |
$4,498.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,175.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,529.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,016.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,270.08
|
| Rate for Payer: Multiplan Commercial |
$4,233.60
|
| Rate for Payer: Networks By Design Commercial |
$3,439.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,498.20
|
|
|
HC LUNG DIFFER PERF & VENTILATION
|
Facility
|
OP
|
$5,292.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
909301402
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$515.47 |
| Max. Negotiated Rate |
$4,498.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,683.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,986.02
|
| Rate for Payer: Blue Distinction Transplant |
$3,175.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,127.57
|
| Rate for Payer: Blue Shield of California EPN |
$2,481.95
|
| Rate for Payer: Cash Price |
$2,381.40
|
| Rate for Payer: Cash Price |
$2,381.40
|
| Rate for Payer: Cigna of CA HMO |
$3,386.88
|
| Rate for Payer: Cigna of CA PPO |
$3,916.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$4,498.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,175.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,969.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,107.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,529.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,270.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$4,233.60
|
| Rate for Payer: Networks By Design Commercial |
$3,439.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,498.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,175.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,175.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$809.82
|
| Rate for Payer: United Healthcare All Other HMO |
$809.82
|
| Rate for Payer: United Healthcare HMO Rider |
$809.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$809.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC LUPUS SCREEN PTT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900912006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$54.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.79
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Media |
$6.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.01
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.86
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC LUTEINIZING HORMON
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
900910886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$168.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$153.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.98
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$23.26
|
| Rate for Payer: Blue Shield of California EPN |
$18.43
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.78
|
| Rate for Payer: Dignity Health Media |
$18.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.52
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.37
|
| Rate for Payer: Heritage Provider Network Transplant |
$30.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$30.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.82
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
|
|
HC LYMPHANGIOGRAM, ABD/PLV UL
|
Facility
|
OP
|
$1,762.00
|
|
|
Service Code
|
CPT 75805
|
| Hospital Charge Code |
909001374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$248.44 |
| Max. Negotiated Rate |
$6,531.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,591.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,592.42
|
| Rate for Payer: Blue Distinction Transplant |
$1,057.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,041.34
|
| Rate for Payer: Blue Shield of California EPN |
$826.38
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cigna of CA HMO |
$1,127.68
|
| Rate for Payer: Cigna of CA PPO |
$1,303.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$1,497.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,057.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,321.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,175.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$1,409.60
|
| Rate for Payer: Networks By Design Commercial |
$1,145.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,497.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,057.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,057.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC LYMPHANGIOGRAM, ABD/PLV UL
|
Facility
|
IP
|
$1,762.00
|
|
|
Service Code
|
CPT 75805
|
| Hospital Charge Code |
909001374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$422.88 |
| Max. Negotiated Rate |
$1,497.70 |
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.80
|
| Rate for Payer: Galaxy Health WC |
$1,497.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,057.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,175.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$671.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.88
|
| Rate for Payer: Multiplan Commercial |
$1,409.60
|
| Rate for Payer: Networks By Design Commercial |
$1,145.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,497.70
|
|
|
HC LYMPHANGIOGRAM EXT BILAT
|
Facility
|
OP
|
$2,638.00
|
|
|
Service Code
|
CPT 75803
|
| Hospital Charge Code |
909001373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.62 |
| Max. Negotiated Rate |
$3,281.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,591.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,414.53
|
| Rate for Payer: Blue Distinction Transplant |
$1,582.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,559.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,237.22
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Cigna of CA HMO |
$1,688.32
|
| Rate for Payer: Cigna of CA PPO |
$1,952.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$2,242.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,978.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,281.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,759.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$2,110.40
|
| Rate for Payer: Networks By Design Commercial |
$1,714.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,242.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,582.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,582.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC LYMPHANGIOGRAM EXT BILAT
|
Facility
|
IP
|
$2,638.00
|
|
|
Service Code
|
CPT 75803
|
| Hospital Charge Code |
909001373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$633.12 |
| Max. Negotiated Rate |
$2,242.30 |
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,055.20
|
| Rate for Payer: Galaxy Health WC |
$2,242.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,759.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,005.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.12
|
| Rate for Payer: Multiplan Commercial |
$2,110.40
|
| Rate for Payer: Networks By Design Commercial |
$1,714.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,242.30
|
|
|
HC LYMPHANGIOGRAM EXT UNILAT
|
Facility
|
OP
|
$1,758.00
|
|
|
Service Code
|
CPT 75801
|
| Hospital Charge Code |
909001375
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.62 |
| Max. Negotiated Rate |
$2,591.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,591.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,414.53
|
| Rate for Payer: Blue Distinction Transplant |
$1,054.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,038.98
|
| Rate for Payer: Blue Shield of California EPN |
$824.50
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna of CA HMO |
$1,125.12
|
| Rate for Payer: Cigna of CA PPO |
$1,300.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,318.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,172.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$1,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,142.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,494.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,054.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,054.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC LYMPHANGIOGRAM EXT UNILAT
|
Facility
|
IP
|
$1,758.00
|
|
|
Service Code
|
CPT 75801
|
| Hospital Charge Code |
909001375
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$421.92 |
| Max. Negotiated Rate |
$1,494.30 |
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.20
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,172.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$669.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.92
|
| Rate for Payer: Multiplan Commercial |
$1,406.40
|
| Rate for Payer: Networks By Design Commercial |
$1,142.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,494.30
|
|
|
HC LYMPHANGIOGRAM, PELV BILAT
|
Facility
|
OP
|
$2,643.00
|
|
|
Service Code
|
CPT 75807
|
| Hospital Charge Code |
909001365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.11 |
| Max. Negotiated Rate |
$6,531.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,591.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,584.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,585.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,562.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,239.57
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cigna of CA HMO |
$1,691.52
|
| Rate for Payer: Cigna of CA PPO |
$1,955.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$2,246.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,982.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$2,114.40
|
| Rate for Payer: Networks By Design Commercial |
$1,717.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,246.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,585.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,585.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC LYMPHANGIOGRAM, PELV BILAT
|
Facility
|
IP
|
$2,643.00
|
|
|
Service Code
|
CPT 75807
|
| Hospital Charge Code |
909001365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$634.32 |
| Max. Negotiated Rate |
$2,246.55 |
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,057.20
|
| Rate for Payer: Galaxy Health WC |
$2,246.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,006.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.32
|
| Rate for Payer: Multiplan Commercial |
$2,114.40
|
| Rate for Payer: Networks By Design Commercial |
$1,717.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,246.55
|
|
