|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
OP
|
$1,386.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.33 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$831.60
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cigna of CA PPO |
$1,025.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,178.10
|
| Rate for Payer: Global Benefits Group Commercial |
$831.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,039.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$924.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,108.80
|
| Rate for Payer: Networks By Design Commercial |
$900.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,178.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$831.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$831.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$693.00
|
| Rate for Payer: United Healthcare All Other HMO |
$693.00
|
| Rate for Payer: United Healthcare HMO Rider |
$693.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$693.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
IP
|
$1,386.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$332.64 |
| Max. Negotiated Rate |
$1,178.10 |
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$554.40
|
| Rate for Payer: Galaxy Health WC |
$1,178.10
|
| Rate for Payer: Global Benefits Group Commercial |
$831.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$924.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$528.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.64
|
| Rate for Payer: Multiplan Commercial |
$1,108.80
|
| Rate for Payer: Networks By Design Commercial |
$900.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,178.10
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
IP
|
$1,386.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.64 |
| Max. Negotiated Rate |
$1,178.10 |
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$554.40
|
| Rate for Payer: Galaxy Health WC |
$1,178.10
|
| Rate for Payer: Global Benefits Group Commercial |
$831.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$924.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$528.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.64
|
| Rate for Payer: Multiplan Commercial |
$1,108.80
|
| Rate for Payer: Networks By Design Commercial |
$900.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,178.10
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
IP
|
$1,386.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$332.64 |
| Max. Negotiated Rate |
$1,178.10 |
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$554.40
|
| Rate for Payer: Galaxy Health WC |
$1,178.10
|
| Rate for Payer: Global Benefits Group Commercial |
$831.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$924.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$528.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.64
|
| Rate for Payer: Multiplan Commercial |
$1,108.80
|
| Rate for Payer: Networks By Design Commercial |
$900.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,178.10
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
OP
|
$1,386.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$156.33 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$831.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,021.48
|
| Rate for Payer: Blue Shield of California EPN |
$809.42
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cigna of CA HMO |
$887.04
|
| Rate for Payer: Cigna of CA PPO |
$1,025.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,178.10
|
| Rate for Payer: Global Benefits Group Commercial |
$831.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,039.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: IEHP Medi-Cal |
$1,399.74
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$924.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,108.80
|
| Rate for Payer: Networks By Design Commercial |
$900.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,178.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$831.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$831.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$831.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
OP
|
$1,386.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.33 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$831.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cigna of CA PPO |
$1,025.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,178.10
|
| Rate for Payer: Global Benefits Group Commercial |
$831.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,039.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: IEHP Medi-Cal |
$1,399.74
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$924.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,108.80
|
| Rate for Payer: Networks By Design Commercial |
$900.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,178.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$831.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$831.60
|
| 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 |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC SPINE 2-3 VIEWS
|
Facility
IP
|
$937.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
909001302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.88 |
| Max. Negotiated Rate |
$796.45 |
| Rate for Payer: Cash Price |
$421.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$374.80
|
| Rate for Payer: Galaxy Health WC |
$796.45
|
| Rate for Payer: Global Benefits Group Commercial |
$562.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$624.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.88
|
| Rate for Payer: Multiplan Commercial |
$749.60
|
| Rate for Payer: Networks By Design Commercial |
$609.05
|
| Rate for Payer: Prime Health Services Commercial |
$796.45
|
|
|
HC SPINE 2-3 VIEWS
|
Facility
OP
|
$937.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
909001302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$796.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$174.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.12
|
| Rate for Payer: BCBS Transplant Transplant |
$562.20
|
| Rate for Payer: Blue Shield of California Commercial |
$553.77
|
| Rate for Payer: Blue Shield of California EPN |
$439.45
|
| Rate for Payer: Cash Price |
$421.65
|
| Rate for Payer: Cash Price |
$421.65
|
| Rate for Payer: Cigna of CA HMO |
$599.68
|
| Rate for Payer: Cigna of CA PPO |
$693.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$796.45
|
| Rate for Payer: Global Benefits Group Commercial |
$562.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$702.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: IEHP Medi-Cal |
$183.93
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$183.93
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$624.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$749.60
|
| Rate for Payer: Networks By Design Commercial |
$609.05
|
| Rate for Payer: Prime Health Services Commercial |
$796.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$562.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$562.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$562.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SPINE MINIMUM 4 VIEWS
|
Facility
OP
|
$1,455.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
909001301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$237.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$234.46
|
| Rate for Payer: BCBS Transplant Transplant |
$873.00
|
| Rate for Payer: Blue Shield of California Commercial |
$859.90
|
| Rate for Payer: Blue Shield of California EPN |
$682.40
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cigna of CA HMO |
$931.20
|
| Rate for Payer: Cigna of CA PPO |
$1,076.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,091.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$873.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$873.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$873.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC SPINE MINIMUM 4 VIEWS
|
Facility
IP
|
$1,455.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
909001301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$349.20 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
|
|
HC SPINE SCAN
|
Facility
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
906601401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$518.88 |
| Max. Negotiated Rate |
$1,837.70 |
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$518.88
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Networks By Design Commercial |
$1,405.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
|
|
HC SPINE SCAN
|
Facility
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
906601401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,837.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$501.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,288.12
|
| Rate for Payer: BCBS Transplant Transplant |
$1,297.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,277.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,013.98
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cigna of CA HMO |
$1,383.68
|
| Rate for Payer: Cigna of CA PPO |
$1,599.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,621.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$518.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Networks By Design Commercial |
$1,405.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,297.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,297.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,297.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC SPINE SINGLE VIEW
|
Facility
OP
|
$824.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
909001325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.87 |
| Max. Negotiated Rate |
$700.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$102.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.93
|
| Rate for Payer: BCBS Transplant Transplant |
$494.40
|
| Rate for Payer: Blue Shield of California Commercial |
$486.98
|
| Rate for Payer: Blue Shield of California EPN |
$386.46
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna of CA HMO |
$527.36
|
| Rate for Payer: Cigna of CA PPO |
$609.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$700.40
|
| Rate for Payer: Global Benefits Group Commercial |
$494.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$618.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: IEHP Medi-Cal |
$183.93
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$183.93
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$549.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$659.20
|
| Rate for Payer: Networks By Design Commercial |
$535.60
|
| Rate for Payer: Prime Health Services Commercial |
$700.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$494.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$494.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$494.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SPINE SINGLE VIEW
|
Facility
IP
|
$824.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
909001325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$197.76 |
| Max. Negotiated Rate |
$700.40 |
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.60
|
| Rate for Payer: Galaxy Health WC |
$700.40
|
| Rate for Payer: Global Benefits Group Commercial |
$494.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$549.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.76
|
| Rate for Payer: Multiplan Commercial |
$659.20
|
| Rate for Payer: Networks By Design Commercial |
$535.60
|
| Rate for Payer: Prime Health Services Commercial |
$700.40
|
|
|
HC SPIROMETRY PHYSICIAN REV & INT
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 94016
|
| Hospital Charge Code |
908600225
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$160.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$60.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.54
|
| Rate for Payer: BCBS Transplant Transplant |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$65.01
|
| Rate for Payer: Blue Shield of California EPN |
$51.59
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Media |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$82.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC SPIROMETRY PHYSICIAN REV & INT
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
CPT 94016
|
| Hospital Charge Code |
908600225
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC SPIROMETRY STUDIES
|
Facility
IP
|
$520.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
900801001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
|
|
HC SPIROMETRY STUDIES
|
Facility
OP
|
$520.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
900801001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$46.74 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$183.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.82
|
| Rate for Payer: BCBS Transplant Transplant |
$312.00
|
| Rate for Payer: Blue Shield of California Commercial |
$307.32
|
| Rate for Payer: Blue Shield of California EPN |
$243.88
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$332.80
|
| Rate for Payer: Cigna of CA PPO |
$384.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$390.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: IEHP Medi-Cal |
$316.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$316.18
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC SPLINT FINGER PADDED LRG 3.25"
|
Facility
OP
|
$5.08
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$37.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.03
|
| Rate for Payer: BCBS Transplant Transplant |
$3.05
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California EPN |
$2.97
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna of CA HMO |
$3.25
|
| Rate for Payer: Cigna of CA PPO |
$3.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.32
|
| Rate for Payer: Dignity Health Media |
$4.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO |
$2.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.32
|
|
|
HC SPLINT FINGER PADDED LRG 3.25"
|
Facility
IP
|
$5.08
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
|
|
HC SPNL PNCTR LMBR DX W/FLUOR/CT
|
Facility
IP
|
$2,404.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
909002328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.96 |
| Max. Negotiated Rate |
$2,043.40 |
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$961.60
|
| Rate for Payer: Galaxy Health WC |
$2,043.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,442.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,603.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$915.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.96
|
| Rate for Payer: Multiplan Commercial |
$1,923.20
|
| Rate for Payer: Networks By Design Commercial |
$1,562.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,043.40
|
|
|
HC SPNL PNCTR LMBR DX W/FLUOR/CT
|
Facility
OP
|
$2,404.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
909002328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.45 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,442.40
|
| 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 |
$1,081.80
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cigna of CA PPO |
$1,778.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$2,043.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,442.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,803.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: IEHP Medi-Cal |
$1,399.74
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,603.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,923.20
|
| Rate for Payer: Networks By Design Commercial |
$1,562.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,043.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,442.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,442.40
|
| 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 |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC SPUTUM COLLECTION
|
Facility
IP
|
$366.00
|
|
|
Service Code
|
CPT 89220
|
| Hospital Charge Code |
900800385
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$87.84 |
| Max. Negotiated Rate |
$311.10 |
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.40
|
| Rate for Payer: Galaxy Health WC |
$311.10
|
| Rate for Payer: Global Benefits Group Commercial |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.84
|
| Rate for Payer: Multiplan Commercial |
$292.80
|
| Rate for Payer: Networks By Design Commercial |
$237.90
|
| Rate for Payer: Prime Health Services Commercial |
$311.10
|
|
|
HC SPUTUM COLLECTION
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
CPT 89220
|
| Hospital Charge Code |
900800385
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$219.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cigna of CA HMO |
$234.24
|
| Rate for Payer: Cigna of CA PPO |
$270.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Media |
$213.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$213.41
|
| Rate for Payer: Galaxy Health WC |
$311.10
|
| Rate for Payer: Global Benefits Group Commercial |
$219.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$274.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$349.99
|
| Rate for Payer: Heritage Provider Network Transplant |
$349.99
|
| Rate for Payer: IEHP Medi-Cal |
$345.72
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$345.72
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.97
|
| Rate for Payer: Multiplan Commercial |
$292.80
|
| Rate for Payer: Networks By Design Commercial |
$237.90
|
| Rate for Payer: Prime Health Services Commercial |
$311.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$219.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC SSA AB
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913521
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$138.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.94
|
| Rate for Payer: BCBS Transplant Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.34
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Media |
$17.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Heritage Provider Network Transplant |
$29.41
|
| Rate for Payer: IEHP Medi-Cal |
$29.05
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$29.05
|
| Rate for Payer: IEHP Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
