|
HC MYELOGRAPHY LUMBAR INJECT T-SPINE
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
909062303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$184.51 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$535.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna of CA HMO |
$1,712.64
|
| Rate for Payer: Cigna of CA PPO |
$1,980.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$2,274.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,605.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,784.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: Multiplan WC |
$1,599.45
|
| Rate for Payer: Networks By Design Commercial |
$1,739.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,274.60
|
| Rate for Payer: Prime Health Services WC |
$1,583.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,605.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY LUMBAR INJECT T-SPINE
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
909062303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$535.20 |
| Max. Negotiated Rate |
$2,274.60 |
| Rate for Payer: Adventist Health Commercial |
$535.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,070.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,070.40
|
| Rate for Payer: Galaxy Health WC |
$2,274.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,605.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,784.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,019.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,656.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.24
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: Networks By Design Commercial |
$1,739.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,274.60
|
|
|
HC MYELOGRAPHY, LUMBOSACRAL
|
Facility
|
OP
|
$2,497.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
909001372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.73 |
| Max. Negotiated Rate |
$2,122.45 |
| Rate for Payer: Adventist Health Commercial |
$499.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,637.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,146.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,528.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,008.79
|
| Rate for Payer: Cash Price |
$1,123.65
|
| Rate for Payer: Cash Price |
$1,123.65
|
| Rate for Payer: Cigna of CA HMO |
$1,598.08
|
| Rate for Payer: Cigna of CA PPO |
$1,847.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$2,122.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$137.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,665.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$1,997.60
|
| Rate for Payer: Networks By Design Commercial |
$1,623.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,122.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,498.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,498.20
|
| 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: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY, LUMBOSACRAL
|
Facility
|
IP
|
$2,497.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
909001372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$499.40 |
| Max. Negotiated Rate |
$2,122.45 |
| Rate for Payer: Adventist Health Commercial |
$499.40
|
| Rate for Payer: Cash Price |
$1,123.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$998.80
|
| Rate for Payer: EPIC Health Plan Senior |
$998.80
|
| Rate for Payer: Galaxy Health WC |
$2,122.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,665.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$951.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,545.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.28
|
| Rate for Payer: Multiplan Commercial |
$1,997.60
|
| Rate for Payer: Networks By Design Commercial |
$1,623.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,122.45
|
|
|
HC MYELOGRAPHY, THORACIC
|
Facility
|
OP
|
$2,498.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
909001371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.19 |
| Max. Negotiated Rate |
$2,123.30 |
| Rate for Payer: Adventist Health Commercial |
$499.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,638.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,218.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,528.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,009.19
|
| Rate for Payer: Cash Price |
$1,124.10
|
| Rate for Payer: Cash Price |
$1,124.10
|
| Rate for Payer: Cigna of CA HMO |
$1,598.72
|
| Rate for Payer: Cigna of CA PPO |
$1,848.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$2,123.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,498.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,666.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$1,998.40
|
| Rate for Payer: Networks By Design Commercial |
$1,623.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,123.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,498.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,498.80
|
| 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: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY, THORACIC
|
Facility
|
IP
|
$2,498.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
909001371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$499.60 |
| Max. Negotiated Rate |
$2,123.30 |
| Rate for Payer: Adventist Health Commercial |
$499.60
|
| Rate for Payer: Cash Price |
$1,124.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$999.20
|
| Rate for Payer: EPIC Health Plan Senior |
$999.20
|
| Rate for Payer: Galaxy Health WC |
$2,123.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,498.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,666.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$951.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,546.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.52
|
| Rate for Payer: Multiplan Commercial |
$1,998.40
|
| Rate for Payer: Networks By Design Commercial |
$1,623.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,123.30
|
|
|
HC MYLOPEROXIDASE AB
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913678
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$46.83
|
| Rate for Payer: Blue Shield of California EPN |
$30.94
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC MYLOPEROXIDASE AB
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913678
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Senior |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
|
|
HC MYOCARDIAL PERFUSION MULTIPLE TEST
|
Facility
|
OP
|
$2,504.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
909301383
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.76 |
| Max. Negotiated Rate |
$2,720.33 |
| Rate for Payer: Adventist Health Commercial |
$500.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,642.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,537.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,532.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,011.62
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna of CA HMO |
$1,602.56
|
| Rate for Payer: Cigna of CA PPO |
$1,852.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$2,128.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,502.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,670.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$2,003.20
|
| Rate for Payer: Networks By Design Commercial |
$1,627.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,128.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,502.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,502.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,721.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,721.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,721.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,721.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC MYOCARDIAL PERFUSION MULTIPLE TEST
|
Facility
|
IP
|
$2,504.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
909301383
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$500.80 |
| Max. Negotiated Rate |
$2,128.40 |
| Rate for Payer: Adventist Health Commercial |
$500.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,001.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.60
|
| Rate for Payer: Galaxy Health WC |
$2,128.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,502.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,670.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$954.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,549.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.96
|
| Rate for Payer: Multiplan Commercial |
$2,003.20
|
| Rate for Payer: Networks By Design Commercial |
$1,627.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,128.40
|
|
|
HC MYOCARDIAL PERFUSION SINGLE
|
Facility
|
OP
|
$3,161.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301385
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$296.69 |
| Max. Negotiated Rate |
$2,720.33 |
| Rate for Payer: Adventist Health Commercial |
$632.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,073.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,941.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,934.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,277.04
|
| Rate for Payer: Cash Price |
$1,422.45
|
| Rate for Payer: Cash Price |
$1,422.45
|
| Rate for Payer: Cigna of CA HMO |
$2,023.04
|
| Rate for Payer: Cigna of CA PPO |
$2,339.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$2,686.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,896.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$296.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,108.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$2,528.80
|
| Rate for Payer: Networks By Design Commercial |
$2,054.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,686.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,896.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,896.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,721.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,721.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,721.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,721.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC MYOCARDIAL PERFUSION SINGLE
|
Facility
|
IP
|
$3,161.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301385
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$632.20 |
| Max. Negotiated Rate |
$2,686.85 |
| Rate for Payer: Adventist Health Commercial |
$632.20
|
| Rate for Payer: Cash Price |
$1,422.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,264.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,264.40
|
| Rate for Payer: Galaxy Health WC |
$2,686.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,896.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,108.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,204.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,956.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.64
|
| Rate for Payer: Multiplan Commercial |
$2,528.80
|
| Rate for Payer: Networks By Design Commercial |
$2,054.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,686.85
|
|
|
HC MYOCARD INFAR/PYP
|
Facility
|
OP
|
$1,437.00
|
|
|
Service Code
|
CPT 78466
|
| Hospital Charge Code |
909301382
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$147.03 |
| Max. Negotiated Rate |
$1,221.45 |
| Rate for Payer: Adventist Health Commercial |
$287.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$942.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$882.46
|
| Rate for Payer: Blue Shield of California Commercial |
$879.44
|
| Rate for Payer: Blue Shield of California EPN |
$580.55
|
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: Cigna of CA HMO |
$919.68
|
| Rate for Payer: Cigna of CA PPO |
$1,063.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,221.45
|
| Rate for Payer: Global Benefits Group Commercial |
$862.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$958.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,149.60
|
| Rate for Payer: Networks By Design Commercial |
$934.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,221.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$862.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$862.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$761.81
|
| Rate for Payer: United Healthcare All Other HMO |
$761.81
|
| Rate for Payer: United Healthcare HMO Rider |
$761.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC MYOCARD INFAR/PYP
|
Facility
|
IP
|
$1,437.00
|
|
|
Service Code
|
CPT 78466
|
| Hospital Charge Code |
909301382
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$287.40 |
| Max. Negotiated Rate |
$1,221.45 |
| Rate for Payer: Adventist Health Commercial |
$287.40
|
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$574.80
|
| Rate for Payer: EPIC Health Plan Senior |
$574.80
|
| Rate for Payer: Galaxy Health WC |
$1,221.45
|
| Rate for Payer: Global Benefits Group Commercial |
$862.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$958.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$547.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$889.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.88
|
| Rate for Payer: Multiplan Commercial |
$1,149.60
|
| Rate for Payer: Networks By Design Commercial |
$934.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,221.45
|
|
|
HC MYOGLOBIN SCREEN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910387
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$22.21 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.21
|
| Rate for Payer: Blue Shield of California Commercial |
$12.04
|
| Rate for Payer: Blue Shield of California EPN |
$7.96
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.25
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HC MYOGLOBIN SCREEN
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910387
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
HC MYOGLOBIN (SERUM)
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Senior |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
|
|
HC MYOGLOBIN (SERUM)
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$127.94 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.94
|
| Rate for Payer: Blue Shield of California Commercial |
$20.07
|
| Rate for Payer: Blue Shield of California EPN |
$13.26
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.44
|
| Rate for Payer: EPIC Health Plan Senior |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.31
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.47
|
| Rate for Payer: United Healthcare All Other HMO |
$10.47
|
| Rate for Payer: United Healthcare HMO Rider |
$10.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.92
|
|
|
HC MYOMO
|
Facility
|
OP
|
$18,750.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
915380020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,500.00 |
| Max. Negotiated Rate |
$15,937.50 |
| Rate for Payer: Adventist Health Commercial |
$7,687.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,937.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,312.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,860.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,837.50
|
| Rate for Payer: Blue Shield of California EPN |
$9,112.50
|
| Rate for Payer: Cash Price |
$8,437.50
|
| Rate for Payer: Cigna of CA HMO |
$13,125.00
|
| Rate for Payer: Cigna of CA PPO |
$13,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,937.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,937.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,500.00
|
| Rate for Payer: Galaxy Health WC |
$15,937.50
|
| Rate for Payer: Global Benefits Group Commercial |
$11,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,143.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,606.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,125.00
|
| Rate for Payer: Multiplan Commercial |
$15,000.00
|
| Rate for Payer: Networks By Design Commercial |
$9,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,937.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,036.88
|
| Rate for Payer: United Healthcare All Other HMO |
$6,849.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,701.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,140.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,937.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,937.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15,937.50
|
|
|
HC MYOMO
|
Facility
|
IP
|
$18,750.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
905380020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$15,937.50 |
| Rate for Payer: Adventist Health Commercial |
$3,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,437.50
|
| Rate for Payer: Cash Price |
$8,437.50
|
| Rate for Payer: Cigna of CA HMO |
$13,125.00
|
| Rate for Payer: Cigna of CA PPO |
$13,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,500.00
|
| Rate for Payer: Galaxy Health WC |
$15,937.50
|
| Rate for Payer: Global Benefits Group Commercial |
$11,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,143.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,606.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,500.00
|
| Rate for Payer: Multiplan Commercial |
$15,000.00
|
| Rate for Payer: Networks By Design Commercial |
$9,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,937.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,036.88
|
| Rate for Payer: United Healthcare All Other HMO |
$6,849.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,701.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,140.62
|
|
|
HC MYOMO
|
Facility
|
IP
|
$18,750.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
915380020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$15,937.50 |
| Rate for Payer: Adventist Health Commercial |
$3,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,437.50
|
| Rate for Payer: Cash Price |
$8,437.50
|
| Rate for Payer: Cigna of CA HMO |
$13,125.00
|
| Rate for Payer: Cigna of CA PPO |
$13,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,500.00
|
| Rate for Payer: Galaxy Health WC |
$15,937.50
|
| Rate for Payer: Global Benefits Group Commercial |
$11,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,143.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,606.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,500.00
|
| Rate for Payer: Multiplan Commercial |
$15,000.00
|
| Rate for Payer: Networks By Design Commercial |
$9,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,937.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,036.88
|
| Rate for Payer: United Healthcare All Other HMO |
$6,849.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,701.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,140.62
|
|
|
HC MYOMO
|
Facility
|
OP
|
$18,750.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
905380020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,500.00 |
| Max. Negotiated Rate |
$15,937.50 |
| Rate for Payer: Adventist Health Commercial |
$7,687.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,937.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,312.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,860.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,837.50
|
| Rate for Payer: Blue Shield of California EPN |
$9,112.50
|
| Rate for Payer: Cash Price |
$8,437.50
|
| Rate for Payer: Cigna of CA HMO |
$13,125.00
|
| Rate for Payer: Cigna of CA PPO |
$13,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,937.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,937.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,500.00
|
| Rate for Payer: Galaxy Health WC |
$15,937.50
|
| Rate for Payer: Global Benefits Group Commercial |
$11,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,143.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,606.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,125.00
|
| Rate for Payer: Multiplan Commercial |
$15,000.00
|
| Rate for Payer: Networks By Design Commercial |
$9,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,937.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,036.88
|
| Rate for Payer: United Healthcare All Other HMO |
$6,849.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,701.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,140.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,937.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,937.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15,937.50
|
|
|
HC MYO-ORTHOSIS
|
Facility
|
OP
|
$6,567.00
|
|
|
Service Code
|
CPT E0770
|
| Hospital Charge Code |
905370770
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$1,313.40 |
| Max. Negotiated Rate |
$5,581.95 |
| Rate for Payer: Adventist Health Commercial |
$1,313.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,307.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,581.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,611.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,925.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,032.79
|
| Rate for Payer: Cash Price |
$2,955.15
|
| Rate for Payer: Cigna of CA HMO |
$4,202.88
|
| Rate for Payer: Cigna of CA PPO |
$4,859.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,581.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,581.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,581.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,626.80
|
| Rate for Payer: Galaxy Health WC |
$5,581.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,064.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,576.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,596.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,596.90
|
| Rate for Payer: Multiplan Commercial |
$5,253.60
|
| Rate for Payer: Networks By Design Commercial |
$4,268.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,581.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,940.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,940.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,283.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,283.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,283.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,581.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,581.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5,581.95
|
|
|
HC MYO-ORTHOSIS
|
Facility
|
IP
|
$6,567.00
|
|
|
Service Code
|
CPT E0770
|
| Hospital Charge Code |
905370770
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$1,313.40 |
| Max. Negotiated Rate |
$5,581.95 |
| Rate for Payer: Adventist Health Commercial |
$1,313.40
|
| Rate for Payer: Cash Price |
$2,955.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,626.80
|
| Rate for Payer: Galaxy Health WC |
$5,581.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,502.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,064.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,576.08
|
| Rate for Payer: Multiplan Commercial |
$5,253.60
|
| Rate for Payer: Networks By Design Commercial |
$4,268.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,581.95
|
|
|
HC MYRINGOTOMY TUBE INFLATION
|
Facility
|
OP
|
$2,329.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
900501377
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.11 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$465.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,048.05
|
| Rate for Payer: Cash Price |
$1,048.05
|
| Rate for Payer: Cash Price |
$1,048.05
|
| Rate for Payer: Cigna of CA HMO |
$1,490.56
|
| Rate for Payer: Cigna of CA PPO |
$1,723.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$1,979.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,397.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,553.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$1,863.20
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$1,513.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,979.65
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,397.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,164.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,164.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,164.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,164.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
