|
HC MRI UPPER EXTREM JOINT WO CONT
|
Facility
IP
|
$5,751.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
908801431
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,380.24 |
| Max. Negotiated Rate |
$4,888.35 |
| Rate for Payer: Cash Price |
$2,587.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,300.40
|
| Rate for Payer: Galaxy Health WC |
$4,888.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,450.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,835.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,191.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,380.24
|
| Rate for Payer: Multiplan Commercial |
$4,600.80
|
| Rate for Payer: Networks By Design Commercial |
$3,738.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,888.35
|
|
|
HC MRI UPPER EXTREM W CONT
|
Facility
OP
|
$3,562.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
908801415
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,122.24
|
| Rate for Payer: BCBS Transplant Transplant |
$2,137.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,105.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,670.58
|
| Rate for Payer: Cash Price |
$1,602.90
|
| Rate for Payer: Cash Price |
$1,602.90
|
| Rate for Payer: Cigna of CA HMO |
$2,279.68
|
| Rate for Payer: Cigna of CA PPO |
$2,635.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,027.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,137.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,671.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: IEHP Medi-Cal |
$778.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$778.41
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,375.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$854.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$2,849.60
|
| Rate for Payer: Networks By Design Commercial |
$2,315.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,027.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,137.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,137.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI UPPER EXTREM W CONT
|
Facility
IP
|
$6,090.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
908801415
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$5,176.50 |
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,436.00
|
| Rate for Payer: Galaxy Health WC |
$5,176.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,654.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,062.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,320.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,461.60
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: Networks By Design Commercial |
$3,958.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,176.50
|
|
|
HC MRI UPPER EXTREM W/O CONT
|
Facility
IP
|
$5,828.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,398.72 |
| Max. Negotiated Rate |
$4,953.80 |
| Rate for Payer: Cash Price |
$2,622.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,331.20
|
| Rate for Payer: Galaxy Health WC |
$4,953.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,496.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,887.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,220.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,398.72
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: Networks By Design Commercial |
$3,788.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,953.80
|
|
|
HC MRI UPPER EXTREM W/O CONT
|
Facility
OP
|
$3,184.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,897.03
|
| Rate for Payer: BCBS Transplant Transplant |
$1,910.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,881.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,493.30
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cigna of CA HMO |
$2,037.76
|
| Rate for Payer: Cigna of CA PPO |
$2,356.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,706.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,910.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,388.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,123.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$2,547.20
|
| Rate for Payer: Networks By Design Commercial |
$2,069.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,706.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,910.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,910.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
IP
|
$7,797.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,871.28 |
| Max. Negotiated Rate |
$6,627.45 |
| Rate for Payer: Cash Price |
$3,508.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,118.80
|
| Rate for Payer: Galaxy Health WC |
$6,627.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,678.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,970.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,871.28
|
| Rate for Payer: Multiplan Commercial |
$6,237.60
|
| Rate for Payer: Networks By Design Commercial |
$5,068.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,627.45
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
OP
|
$3,746.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,231.87
|
| Rate for Payer: BCBS Transplant Transplant |
$2,247.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,213.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.87
|
| Rate for Payer: Cash Price |
$1,685.70
|
| Rate for Payer: Cash Price |
$1,685.70
|
| Rate for Payer: Cigna of CA HMO |
$2,397.44
|
| Rate for Payer: Cigna of CA PPO |
$2,772.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,184.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,247.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,809.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: IEHP Medi-Cal |
$778.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$778.41
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,498.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$899.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$2,996.80
|
| Rate for Payer: Networks By Design Commercial |
$2,434.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,184.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,247.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,247.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRSA DNA
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
900912328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$313.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$313.26
|
| Rate for Payer: BCBS Transplant Transplant |
$61.80
|
| Rate for Payer: Blue Shield of California Commercial |
$66.54
|
| Rate for Payer: Blue Shield of California EPN |
$52.74
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO |
$65.92
|
| Rate for Payer: Cigna of CA PPO |
$76.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Media |
$35.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$77.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Transplant |
$57.55
|
| Rate for Payer: IEHP Medi-Cal |
$56.85
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$56.85
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$66.95
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$61.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC MULTIFETAL PREG REDUCTION MPR
|
Facility
OP
|
$583.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.92 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,400.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$349.80
|
| Rate for Payer: Blue Shield of California Commercial |
$429.67
|
| Rate for Payer: Blue Shield of California EPN |
$340.47
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cigna of CA HMO |
$373.12
|
| Rate for Payer: Cigna of CA PPO |
$431.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$437.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: IEHP Medi-Cal |
$649.33
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$649.33
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$349.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$349.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$349.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.50
|
| Rate for Payer: United Healthcare All Other HMO |
$291.50
|
| Rate for Payer: United Healthcare HMO Rider |
$291.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC MULTIFETAL PREG REDUCTION MPR
|
Facility
IP
|
$583.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.92 |
| Max. Negotiated Rate |
$495.55 |
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.20
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.92
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
|
|
HC MULTIFETAL PREG REDUCTION MPR ADDL FETUS
|
Facility
IP
|
$583.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.92 |
| Max. Negotiated Rate |
$495.55 |
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.20
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.92
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
|
|
HC MULTIFETAL PREG REDUCTION MPR ADDL FETUS
|
Facility
OP
|
$583.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.92 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,400.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$349.80
|
| Rate for Payer: Blue Shield of California Commercial |
$429.67
|
| Rate for Payer: Blue Shield of California EPN |
$340.47
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cigna of CA HMO |
$373.12
|
| Rate for Payer: Cigna of CA PPO |
$431.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$437.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: IEHP Medi-Cal |
$649.33
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$649.33
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$349.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$349.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$349.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.50
|
| Rate for Payer: United Healthcare All Other HMO |
$291.50
|
| Rate for Payer: United Healthcare HMO Rider |
$291.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC MULTI-PLANAR RECON
|
Facility
OP
|
$2,175.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,848.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,196.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,196.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,295.86
|
| Rate for Payer: BCBS Transplant Transplant |
$1,305.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,602.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,270.20
|
| Rate for Payer: Cash Price |
$978.75
|
| Rate for Payer: Cash Price |
$978.75
|
| Rate for Payer: Cigna of CA HMO |
$1,392.00
|
| Rate for Payer: Cigna of CA PPO |
$1,609.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,848.75
|
| Rate for Payer: Dignity Health Media |
$1,848.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,848.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$870.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$870.00
|
| Rate for Payer: Galaxy Health WC |
$1,848.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,305.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,631.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,450.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$828.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.00
|
| Rate for Payer: Multiplan Commercial |
$1,740.00
|
| Rate for Payer: Networks By Design Commercial |
$1,413.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,848.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,305.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,305.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,087.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,087.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,087.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,848.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,848.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,848.75
|
|
|
HC MULTI-PLANAR RECON
|
Facility
IP
|
$2,175.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$1,848.75 |
| Rate for Payer: Cash Price |
$978.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$870.00
|
| Rate for Payer: Galaxy Health WC |
$1,848.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,305.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,450.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$828.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.00
|
| Rate for Payer: Multiplan Commercial |
$1,740.00
|
| Rate for Payer: Networks By Design Commercial |
$1,413.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,848.75
|
|
|
HC MUMPS AB
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913533
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$120.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.33
|
| Rate for Payer: BCBS Transplant Transplant |
$16.20
|
| Rate for Payer: Blue Shield of California Commercial |
$17.44
|
| Rate for Payer: Blue Shield of California EPN |
$13.82
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.58
|
| Rate for Payer: Dignity Health Media |
$13.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.05
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.40
|
| Rate for Payer: IEHP Medi-Cal |
$21.14
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$21.14
|
| Rate for Payer: IEHP Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC MUMPS ANTIBODY
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913663
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$120.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.33
|
| Rate for Payer: BCBS Transplant Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.58
|
| Rate for Payer: Dignity Health Media |
$13.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.05
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.40
|
| Rate for Payer: IEHP Medi-Cal |
$21.14
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$21.14
|
| Rate for Payer: IEHP Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$3,281.62
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,714.20
|
| 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 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 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: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$1,620.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,620.65
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,762.80
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$1,620.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,620.65
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,941.00
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$1,620.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,620.65
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,642.80
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$1,620.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,620.65
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,762.80
|
| 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
|
|
