|
HC MUSCLE BIOPSY, PERCUTANEOUS
|
Facility
|
IP
|
$2,857.00
|
|
|
Service Code
|
CPT 20206
|
| Hospital Charge Code |
909000105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$685.68 |
| Max. Negotiated Rate |
$2,428.45 |
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,088.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Networks By Design Commercial |
$1,857.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
|
|
HC MUSCLE BIOPSY, PERCUTANEOUS
|
Facility
|
OP
|
$2,857.00
|
|
|
Service Code
|
CPT 20206
|
| Hospital Charge Code |
909000105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.21 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,714.20
|
| 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 |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cigna of CA PPO |
$2,114.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,142.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Networks By Design Commercial |
$1,857.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,714.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC MYELOGRAM, CERVICAL
|
Facility
|
OP
|
$2,938.00
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
909001363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.34 |
| Max. Negotiated Rate |
$2,497.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$635.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,232.78
|
| Rate for Payer: Blue Distinction Transplant |
$1,762.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,736.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,377.92
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cigna of CA HMO |
$1,880.32
|
| Rate for Payer: Cigna of CA PPO |
$2,174.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,203.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,640.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,909.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,265.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,265.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,265.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAM, CERVICAL
|
Facility
|
IP
|
$2,938.00
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
909001363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$705.12 |
| Max. Negotiated Rate |
$2,497.30 |
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.12
|
| Rate for Payer: Multiplan Commercial |
$2,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,909.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
|
|
HC MYELOGRAM, COMPLETE
|
Facility
|
IP
|
$3,235.00
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
909001364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$776.40 |
| Max. Negotiated Rate |
$2,749.75 |
| Rate for Payer: Cash Price |
$1,455.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,294.00
|
| Rate for Payer: Galaxy Health WC |
$2,749.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,941.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,157.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,232.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.40
|
| Rate for Payer: Multiplan Commercial |
$2,588.00
|
| Rate for Payer: Networks By Design Commercial |
$2,102.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,749.75
|
|
|
HC MYELOGRAM, COMPLETE
|
Facility
|
OP
|
$3,235.00
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
909001364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.55 |
| Max. Negotiated Rate |
$2,749.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$951.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,584.06
|
| Rate for Payer: Blue Distinction Transplant |
$1,941.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,911.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,517.22
|
| Rate for Payer: Cash Price |
$1,455.75
|
| Rate for Payer: Cash Price |
$1,455.75
|
| Rate for Payer: Cigna of CA HMO |
$2,070.40
|
| Rate for Payer: Cigna of CA PPO |
$2,393.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,749.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,941.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,426.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,640.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,157.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,588.00
|
| Rate for Payer: Networks By Design Commercial |
$2,102.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,749.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,941.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,941.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,265.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,265.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,265.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAPHY LUMBAR INJECT T-SPINE
|
Facility
|
OP
|
$2,738.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
909062303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.68 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,642.80
|
| 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 |
$1,232.10
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna of CA PPO |
$2,026.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,327.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,642.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,053.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,640.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,826.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,190.40
|
| Rate for Payer: Networks By Design Commercial |
$1,779.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,327.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,642.80
|
| 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 |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAPHY LUMBAR INJECT T-SPINE
|
Facility
|
IP
|
$2,738.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
909062303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$657.12 |
| Max. Negotiated Rate |
$2,327.30 |
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,095.20
|
| Rate for Payer: Galaxy Health WC |
$2,327.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,642.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,826.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,043.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.12
|
| Rate for Payer: Multiplan Commercial |
$2,190.40
|
| Rate for Payer: Networks By Design Commercial |
$1,779.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,327.30
|
|
|
HC MYELOGRAPHY, LUMBOSACRAL
|
Facility
|
OP
|
$2,938.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
909001372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.76 |
| Max. Negotiated Rate |
$2,497.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$617.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,058.58
|
| Rate for Payer: Blue Distinction Transplant |
$1,762.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,736.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,377.92
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cigna of CA HMO |
$1,880.32
|
| Rate for Payer: Cigna of CA PPO |
$2,174.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,203.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,640.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,909.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,265.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,265.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,265.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAPHY, LUMBOSACRAL
|
Facility
|
IP
|
$2,938.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
909001372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$705.12 |
| Max. Negotiated Rate |
$2,497.30 |
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.12
|
| Rate for Payer: Multiplan Commercial |
$2,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,909.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
|
|
HC MYELOGRAPHY, THORACIC
|
Facility
|
IP
|
$2,939.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
909001371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$705.36 |
| Max. Negotiated Rate |
$2,498.15 |
| Rate for Payer: Cash Price |
$1,322.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.60
|
| Rate for Payer: Galaxy Health WC |
$2,498.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,763.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.36
|
| Rate for Payer: Multiplan Commercial |
$2,351.20
|
| Rate for Payer: Networks By Design Commercial |
$1,910.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,498.15
|
|
|
HC MYELOGRAPHY, THORACIC
|
Facility
|
OP
|
$2,939.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
909001371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.34 |
| Max. Negotiated Rate |
$2,498.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$583.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,125.29
|
| Rate for Payer: Blue Distinction Transplant |
$1,763.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,736.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,378.39
|
| Rate for Payer: Cash Price |
$1,322.55
|
| Rate for Payer: Cash Price |
$1,322.55
|
| Rate for Payer: Cigna of CA HMO |
$1,880.96
|
| Rate for Payer: Cigna of CA PPO |
$2,174.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,498.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,763.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,204.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,640.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,351.20
|
| Rate for Payer: Networks By Design Commercial |
$1,910.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,498.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,763.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,763.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,265.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,265.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,265.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYLOPEROXIDASE AB
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913678
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$213.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.45
|
| Rate for Payer: Blue Distinction Transplant |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$47.16
|
| Rate for Payer: Blue Shield of California EPN |
$37.38
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Media |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC MYOCARDIAL PERFUSION MULTIPLE TEST
|
Facility
|
OP
|
$2,946.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
909301383
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$319.79 |
| Max. Negotiated Rate |
$2,909.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,283.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,755.23
|
| Rate for Payer: Blue Distinction Transplant |
$1,767.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,741.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,381.67
|
| Rate for Payer: Cash Price |
$1,325.70
|
| Rate for Payer: Cash Price |
$1,325.70
|
| Rate for Payer: Cigna of CA HMO |
$1,885.44
|
| Rate for Payer: Cigna of CA PPO |
$2,180.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$2,504.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,767.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,209.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,909.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,909.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,874.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,874.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,964.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$2,356.80
|
| Rate for Payer: Networks By Design Commercial |
$1,914.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,767.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,767.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,721.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,721.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,721.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,721.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC MYOCARDIAL PERFUSION MULTIPLE TEST
|
Facility
|
IP
|
$2,946.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
909301383
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$707.04 |
| Max. Negotiated Rate |
$2,504.10 |
| Rate for Payer: Cash Price |
$1,325.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.40
|
| Rate for Payer: Galaxy Health WC |
$2,504.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,767.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,964.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,122.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.04
|
| Rate for Payer: Multiplan Commercial |
$2,356.80
|
| Rate for Payer: Networks By Design Commercial |
$1,914.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.10
|
|
|
HC MYOCARDIAL PERFUSION SINGLE
|
Facility
|
IP
|
$3,719.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301385
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$892.56 |
| Max. Negotiated Rate |
$3,161.15 |
| Rate for Payer: Cash Price |
$1,673.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,487.60
|
| Rate for Payer: Galaxy Health WC |
$3,161.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,231.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,480.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,416.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.56
|
| Rate for Payer: Multiplan Commercial |
$2,975.20
|
| Rate for Payer: Networks By Design Commercial |
$2,417.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,161.15
|
|
|
HC MYOCARDIAL PERFUSION SINGLE
|
Facility
|
OP
|
$3,719.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301385
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$335.54 |
| Max. Negotiated Rate |
$3,161.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,557.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,215.78
|
| Rate for Payer: Blue Distinction Transplant |
$2,231.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,197.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,744.21
|
| Rate for Payer: Cash Price |
$1,673.55
|
| Rate for Payer: Cash Price |
$1,673.55
|
| Rate for Payer: Cigna of CA HMO |
$2,380.16
|
| Rate for Payer: Cigna of CA PPO |
$2,752.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$3,161.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,231.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,789.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,909.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,909.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,874.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,874.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,480.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$2,975.20
|
| Rate for Payer: Networks By Design Commercial |
$2,417.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,161.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,231.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,231.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,721.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,721.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,721.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,721.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC MYOCARD INFAR/PYP
|
Facility
|
OP
|
$1,691.00
|
|
|
Service Code
|
CPT 78466
|
| Hospital Charge Code |
909301382
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$166.29 |
| Max. Negotiated Rate |
$1,437.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$925.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,007.50
|
| Rate for Payer: Blue Distinction Transplant |
$1,014.60
|
| Rate for Payer: Blue Shield of California Commercial |
$999.38
|
| Rate for Payer: Blue Shield of California EPN |
$793.08
|
| Rate for Payer: Cash Price |
$760.95
|
| Rate for Payer: Cash Price |
$760.95
|
| Rate for Payer: Cigna of CA HMO |
$1,082.24
|
| Rate for Payer: Cigna of CA PPO |
$1,251.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,437.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,268.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,352.80
|
| Rate for Payer: Networks By Design Commercial |
$1,099.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,437.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,014.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,014.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$761.81
|
| Rate for Payer: United Healthcare All Other HMO |
$761.81
|
| Rate for Payer: United Healthcare HMO Rider |
$761.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC MYOCARD INFAR/PYP
|
Facility
|
IP
|
$1,691.00
|
|
|
Service Code
|
CPT 78466
|
| Hospital Charge Code |
909301382
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$405.84 |
| Max. Negotiated Rate |
$1,437.35 |
| Rate for Payer: Cash Price |
$760.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.40
|
| Rate for Payer: Galaxy Health WC |
$1,437.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.84
|
| Rate for Payer: Multiplan Commercial |
$1,352.80
|
| Rate for Payer: Networks By Design Commercial |
$1,099.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,437.35
|
|
|
HC MYOGLOBIN SCREEN
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910387
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$20.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.52
|
| Rate for Payer: Blue Distinction Transplant |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7.11
|
| Rate for Payer: Blue Shield of California EPN |
$5.63
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: Dignity Health Media |
$2.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.25
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$3.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HC MYOGLOBIN (SERUM)
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$118.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.18
|
| 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 |
$19.38
|
| Rate for Payer: Dignity Health Media |
$12.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.92
|
| 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 |
$21.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$20.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.31
|
| 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 |
$10.47
|
| Rate for Payer: United Healthcare All Other HMO |
$10.47
|
| Rate for Payer: United Healthcare HMO Rider |
$10.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.92
|
|
|
HC MYO-ORTHOSIS
|
Facility
|
IP
|
$6,567.00
|
|
|
Service Code
|
CPT E0770
|
| Hospital Charge Code |
905370770
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$1,576.08 |
| Max. Negotiated Rate |
$5,581.95 |
| Rate for Payer: Cash Price |
$2,955.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,626.80
|
| Rate for Payer: Galaxy Health WC |
$5,581.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,502.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,576.08
|
| Rate for Payer: Multiplan Commercial |
$5,253.60
|
| Rate for Payer: Networks By Design Commercial |
$4,268.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,581.95
|
|
|
HC MYO-ORTHOSIS
|
Facility
|
OP
|
$6,567.00
|
|
|
Service Code
|
CPT E0770
|
| Hospital Charge Code |
905370770
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$1,576.08 |
| Max. Negotiated Rate |
$5,581.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,075.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,581.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,611.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,611.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,912.62
|
| Rate for Payer: Blue Distinction Transplant |
$3,940.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,839.88
|
| Rate for Payer: Blue Shield of California EPN |
$3,835.13
|
| Rate for Payer: Cash Price |
$2,955.15
|
| Rate for Payer: Cash Price |
$2,955.15
|
| Rate for Payer: Cigna of CA HMO |
$4,202.88
|
| Rate for Payer: Cigna of CA PPO |
$4,859.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,581.95
|
| Rate for Payer: Dignity Health Media |
$5,581.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,581.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,626.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,626.80
|
| Rate for Payer: Galaxy Health WC |
$5,581.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,925.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,576.08
|
| Rate for Payer: Multiplan Commercial |
$5,253.60
|
| Rate for Payer: Networks By Design Commercial |
$4,268.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,581.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,940.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,940.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,283.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,283.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,283.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,581.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,581.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5,581.95
|
|
|
HC MYRINGOTOMY TUBE INFLATION
|
Facility
|
IP
|
$2,383.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
900501377
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$571.92 |
| Max. Negotiated Rate |
$2,025.55 |
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$953.20
|
| Rate for Payer: Galaxy Health WC |
$2,025.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,429.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,589.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$907.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.92
|
| Rate for Payer: Multiplan Commercial |
$1,906.40
|
| Rate for Payer: Networks By Design Commercial |
$1,548.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,025.55
|
|
|
HC MYRINGOTOMY TUBE INFLATION
|
Facility
|
OP
|
$2,383.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
900501377
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.12 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,429.80
|
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Cigna of CA PPO |
$1,763.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$2,025.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,429.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,787.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,589.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$1,906.40
|
| Rate for Payer: Networks By Design Commercial |
$1,548.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,025.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,429.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,191.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,191.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,191.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,191.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
