|
HC SPINAL LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
IP
|
$3,180.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
909000180
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$2,862.00 |
| Rate for Payer: Adventist Health Commercial |
$636.00
|
| Rate for Payer: Cash Price |
$1,749.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,272.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,272.00
|
| Rate for Payer: Galaxy Health WC |
$2,703.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,908.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,862.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,121.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,211.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,968.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.00
|
| Rate for Payer: Multiplan Commercial |
$2,385.00
|
| Rate for Payer: Networks By Design Commercial |
$2,067.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,703.00
|
|
|
HC SPINAL LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
IP
|
$3,180.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
909000180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$2,862.00 |
| Rate for Payer: Adventist Health Commercial |
$636.00
|
| Rate for Payer: Cash Price |
$1,749.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,272.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,272.00
|
| Rate for Payer: Galaxy Health WC |
$2,703.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,908.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,862.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,121.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,211.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,968.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.00
|
| Rate for Payer: Multiplan Commercial |
$2,385.00
|
| Rate for Payer: Networks By Design Commercial |
$2,067.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,703.00
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
|
IP
|
$1,833.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$366.60 |
| Max. Negotiated Rate |
$1,649.70 |
| Rate for Payer: Adventist Health Commercial |
$366.60
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,466.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$733.20
|
| Rate for Payer: EPIC Health Plan Senior |
$733.20
|
| Rate for Payer: Galaxy Health WC |
$1,558.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,649.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,222.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$698.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,134.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.60
|
| Rate for Payer: Multiplan Commercial |
$1,374.75
|
| Rate for Payer: Networks By Design Commercial |
$1,191.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,558.05
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
|
OP
|
$1,833.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$141.52 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$366.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$879.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,119.96
|
| Rate for Payer: Blue Shield of California EPN |
$731.37
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,466.40
|
| Rate for Payer: Cigna of CA HMO |
$1,173.12
|
| Rate for Payer: Cigna of CA PPO |
$1,356.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,558.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,649.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,222.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,374.75
|
| Rate for Payer: Networks By Design Commercial |
$1,191.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Prime Health Services Commercial |
$1,558.05
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,099.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,099.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
|
IP
|
$1,833.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$366.60 |
| Max. Negotiated Rate |
$1,649.70 |
| Rate for Payer: Adventist Health Commercial |
$366.60
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,466.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$733.20
|
| Rate for Payer: EPIC Health Plan Senior |
$733.20
|
| Rate for Payer: Galaxy Health WC |
$1,558.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,649.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,222.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$698.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,134.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.60
|
| Rate for Payer: Multiplan Commercial |
$1,374.75
|
| Rate for Payer: Networks By Design Commercial |
$1,191.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,558.05
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
|
IP
|
$1,833.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$366.60 |
| Max. Negotiated Rate |
$1,649.70 |
| Rate for Payer: Adventist Health Commercial |
$366.60
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,466.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$733.20
|
| Rate for Payer: EPIC Health Plan Senior |
$733.20
|
| Rate for Payer: Galaxy Health WC |
$1,558.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,649.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,222.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$698.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,134.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.60
|
| Rate for Payer: Multiplan Commercial |
$1,374.75
|
| Rate for Payer: Networks By Design Commercial |
$1,191.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,558.05
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
|
IP
|
$1,833.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$366.60 |
| Max. Negotiated Rate |
$1,649.70 |
| Rate for Payer: Adventist Health Commercial |
$366.60
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,466.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$733.20
|
| Rate for Payer: EPIC Health Plan Senior |
$733.20
|
| Rate for Payer: Galaxy Health WC |
$1,558.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,649.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,222.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$698.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,134.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.60
|
| Rate for Payer: Multiplan Commercial |
$1,374.75
|
| Rate for Payer: Networks By Design Commercial |
$1,191.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,558.05
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
|
OP
|
$1,833.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$156.33 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$751.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,466.40
|
| Rate for Payer: Cigna of CA HMO |
$1,173.12
|
| Rate for Payer: Cigna of CA PPO |
$1,356.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,558.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,649.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,222.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,374.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,191.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$1,558.05
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,099.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,099.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
|
OP
|
$1,833.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.33 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$366.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,466.40
|
| Rate for Payer: Cigna of CA HMO |
$1,173.12
|
| Rate for Payer: Cigna of CA PPO |
$1,356.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,558.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,649.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,222.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,374.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,191.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$1,558.05
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,099.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$916.50
|
| Rate for Payer: United Healthcare All Other HMO |
$916.50
|
| Rate for Payer: United Healthcare HMO Rider |
$916.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$916.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
|
OP
|
$1,833.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$141.52 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$366.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$879.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,466.40
|
| Rate for Payer: Cigna of CA HMO |
$1,173.12
|
| Rate for Payer: Cigna of CA PPO |
$1,356.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,558.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,649.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,222.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,374.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,191.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$1,558.05
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,099.80
|
| 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 |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC SPINE 2-3 VIEWS
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
909001302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$226.60 |
| Max. Negotiated Rate |
$1,019.70 |
| Rate for Payer: Adventist Health Commercial |
$226.60
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Central Health Plan Commercial |
$906.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.20
|
| Rate for Payer: EPIC Health Plan Senior |
$453.20
|
| Rate for Payer: Galaxy Health WC |
$963.05
|
| Rate for Payer: Global Benefits Group Commercial |
$679.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,019.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$701.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.60
|
| Rate for Payer: Multiplan Commercial |
$849.75
|
| Rate for Payer: Networks By Design Commercial |
$736.45
|
| Rate for Payer: Prime Health Services Commercial |
$963.05
|
|
|
HC SPINE 2-3 VIEWS
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
909001302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.43 |
| Max. Negotiated Rate |
$1,019.70 |
| Rate for Payer: Adventist Health Commercial |
$226.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$688.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$125.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.43
|
| Rate for Payer: Blue Shield of California Commercial |
$687.73
|
| Rate for Payer: Blue Shield of California EPN |
$449.80
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Cash Price |
$623.15
|
| Rate for Payer: Central Health Plan Commercial |
$906.40
|
| Rate for Payer: Cigna of CA HMO |
$725.12
|
| Rate for Payer: Cigna of CA PPO |
$838.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$963.05
|
| Rate for Payer: Global Benefits Group Commercial |
$679.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,019.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$849.75
|
| Rate for Payer: Networks By Design Commercial |
$736.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$963.05
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$679.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$679.80
|
| 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: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SPINE MINIMUM 4 VIEWS
|
Facility
|
IP
|
$1,758.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
909001301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$1,582.20 |
| Rate for Payer: Adventist Health Commercial |
$351.60
|
| Rate for Payer: Cash Price |
$966.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.20
|
| Rate for Payer: EPIC Health Plan Senior |
$703.20
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,582.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,172.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$669.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,088.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.60
|
| Rate for Payer: Multiplan Commercial |
$1,318.50
|
| Rate for Payer: Networks By Design Commercial |
$1,142.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,494.30
|
|
|
HC SPINE MINIMUM 4 VIEWS
|
Facility
|
OP
|
$1,758.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
909001301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.94 |
| Max. Negotiated Rate |
$1,582.20 |
| Rate for Payer: Adventist Health Commercial |
$351.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,067.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$186.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,067.11
|
| Rate for Payer: Blue Shield of California EPN |
$697.93
|
| Rate for Payer: Cash Price |
$966.90
|
| Rate for Payer: Cash Price |
$966.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,406.40
|
| Rate for Payer: Cigna of CA HMO |
$1,125.12
|
| Rate for Payer: Cigna of CA PPO |
$1,300.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,582.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,172.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,318.50
|
| Rate for Payer: Networks By Design Commercial |
$1,142.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,494.30
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,054.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,054.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$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: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SPINE SCAN
|
Facility
|
IP
|
$2,430.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
906601401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Adventist Health Commercial |
$486.00
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,944.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$972.00
|
| Rate for Payer: EPIC Health Plan Senior |
$972.00
|
| Rate for Payer: Galaxy Health WC |
$2,065.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,458.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,187.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,620.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$925.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,504.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Multiplan Commercial |
$1,822.50
|
| Rate for Payer: Networks By Design Commercial |
$1,579.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,065.50
|
|
|
HC SPINE SCAN
|
Facility
|
OP
|
$2,430.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
906601401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Adventist Health Commercial |
$486.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,475.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$299.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,427.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,475.01
|
| Rate for Payer: Blue Shield of California EPN |
$964.71
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,944.00
|
| Rate for Payer: Cigna of CA HMO |
$1,555.20
|
| Rate for Payer: Cigna of CA PPO |
$1,798.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$2,065.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,458.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,187.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$139.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,620.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,822.50
|
| Rate for Payer: Networks By Design Commercial |
$1,579.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,065.50
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,458.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,458.00
|
| 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: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SPINE SINGLE VIEW
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
909001325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.00 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Adventist Health Commercial |
$199.00
|
| Rate for Payer: Cash Price |
$547.25
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.00
|
| Rate for Payer: EPIC Health Plan Senior |
$398.00
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$615.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
|
|
HC SPINE SINGLE VIEW
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
909001325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Adventist Health Commercial |
$199.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$604.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.95
|
| Rate for Payer: Blue Shield of California Commercial |
$603.97
|
| Rate for Payer: Blue Shield of California EPN |
$395.01
|
| Rate for Payer: Cash Price |
$547.25
|
| Rate for Payer: Cash Price |
$547.25
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: Cigna of CA HMO |
$636.80
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.00
|
| 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: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SPIROMETRY STUDIES
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
900801001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$556.20 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Central Health Plan Commercial |
$494.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$247.20
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$556.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
|
|
HC SPIROMETRY STUDIES
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
900801001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$375.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$362.95
|
| Rate for Payer: Blue Shield of California Commercial |
$375.13
|
| Rate for Payer: Blue Shield of California EPN |
$245.35
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Central Health Plan Commercial |
$494.40
|
| Rate for Payer: Cigna of CA HMO |
$395.52
|
| Rate for Payer: Cigna of CA PPO |
$457.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$556.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$370.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC SPLINT AIR FOOT/ANKLE
|
Facility
|
IP
|
$58.22
|
|
| Hospital Charge Code |
901698231
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.64 |
| Max. Negotiated Rate |
$52.40 |
| Rate for Payer: Adventist Health Commercial |
$11.64
|
| Rate for Payer: Cash Price |
$32.02
|
| Rate for Payer: Central Health Plan Commercial |
$46.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.29
|
| Rate for Payer: EPIC Health Plan Senior |
$23.29
|
| Rate for Payer: Galaxy Health WC |
$49.49
|
| Rate for Payer: Global Benefits Group Commercial |
$34.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.64
|
| Rate for Payer: Multiplan Commercial |
$43.66
|
| Rate for Payer: Networks By Design Commercial |
$37.84
|
| Rate for Payer: Prime Health Services Commercial |
$49.49
|
|
|
HC SPLINT AIR FOOT/ANKLE
|
Facility
|
OP
|
$58.22
|
|
| Hospital Charge Code |
901698231
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.64 |
| Max. Negotiated Rate |
$52.40 |
| Rate for Payer: Adventist Health Commercial |
$11.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.19
|
| Rate for Payer: Blue Shield of California Commercial |
$35.57
|
| Rate for Payer: Blue Shield of California EPN |
$23.23
|
| Rate for Payer: Cash Price |
$32.02
|
| Rate for Payer: Central Health Plan Commercial |
$46.58
|
| Rate for Payer: Cigna of CA HMO |
$37.26
|
| Rate for Payer: Cigna of CA PPO |
$43.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.29
|
| Rate for Payer: EPIC Health Plan Senior |
$23.29
|
| Rate for Payer: Galaxy Health WC |
$49.49
|
| Rate for Payer: Global Benefits Group Commercial |
$34.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.40
|
| Rate for Payer: InnovAge PACE Commercial |
$29.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.75
|
| Rate for Payer: Multiplan Commercial |
$43.66
|
| Rate for Payer: Networks By Design Commercial |
$37.84
|
| Rate for Payer: Prime Health Services Commercial |
$49.49
|
| Rate for Payer: Riverside University Health System MISP |
$23.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.11
|
| Rate for Payer: United Healthcare All Other HMO |
$29.11
|
| Rate for Payer: United Healthcare HMO Rider |
$29.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.49
|
| Rate for Payer: Vantage Medical Group Senior |
$49.49
|
|
|
HC SPLINT AIR HALF ARM
|
Facility
|
IP
|
$54.12
|
|
| Hospital Charge Code |
901698230
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Cash Price |
$29.77
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
|
|
HC SPLINT AIR HALF ARM
|
Facility
|
OP
|
$54.12
|
|
| Hospital Charge Code |
901698230
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.78
|
| Rate for Payer: Blue Shield of California Commercial |
$33.07
|
| Rate for Payer: Blue Shield of California EPN |
$21.59
|
| Rate for Payer: Cash Price |
$29.77
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$34.64
|
| Rate for Payer: Cigna of CA PPO |
$40.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: InnovAge PACE Commercial |
$27.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.88
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
| Rate for Payer: Riverside University Health System MISP |
$21.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.06
|
| Rate for Payer: United Healthcare All Other HMO |
$27.06
|
| Rate for Payer: United Healthcare HMO Rider |
$27.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.00
|
| Rate for Payer: Vantage Medical Group Senior |
$46.00
|
|
|
HC SPLINT AIR HALF LEG
|
Facility
|
IP
|
$68.06
|
|
| Hospital Charge Code |
901698232
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$61.25 |
| Rate for Payer: Adventist Health Commercial |
$13.61
|
| Rate for Payer: Cash Price |
$37.43
|
| Rate for Payer: Central Health Plan Commercial |
$54.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.22
|
| Rate for Payer: EPIC Health Plan Senior |
$27.22
|
| Rate for Payer: Galaxy Health WC |
$57.85
|
| Rate for Payer: Global Benefits Group Commercial |
$40.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.61
|
| Rate for Payer: Multiplan Commercial |
$51.05
|
| Rate for Payer: Networks By Design Commercial |
$44.24
|
| Rate for Payer: Prime Health Services Commercial |
$57.85
|
|
