|
HC CT TSPINE W CONTRAST
|
Facility
|
IP
|
$5,733.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
909201918
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,146.60 |
| Max. Negotiated Rate |
$5,159.70 |
| Rate for Payer: Cash Price |
$2,579.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,586.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,293.20
|
| Rate for Payer: Galaxy Health WC |
$4,873.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,439.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,159.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,823.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,184.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,146.60
|
| Rate for Payer: Multiplan Commercial |
$4,299.75
|
| Rate for Payer: Networks By Design Commercial |
$3,726.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,873.05
|
|
|
HC CT TSPINE WO CONTRAST
|
Facility
|
IP
|
$5,345.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
909201917
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$4,810.50 |
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,276.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,138.00
|
| Rate for Payer: Galaxy Health WC |
$4,543.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,207.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,810.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,565.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,036.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,069.00
|
| Rate for Payer: Multiplan Commercial |
$4,008.75
|
| Rate for Payer: Networks By Design Commercial |
$3,474.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,543.25
|
|
|
HC CT TSPINE WO CONTRAST
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
909201917
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,220.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,772.40
|
| Rate for Payer: Blue Distinction Transplant |
$1,800.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,854.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,458.00
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,400.00
|
| Rate for Payer: Cigna of CA HMO |
$1,920.00
|
| Rate for Payer: Cigna of CA PPO |
$2,220.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$2,550.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,800.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,700.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,250.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,001.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,550.00
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,800.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT TSPINE W W/O CONTRAST
|
Facility
|
IP
|
$6,019.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
909201966
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,203.80 |
| Max. Negotiated Rate |
$5,417.10 |
| Rate for Payer: Cash Price |
$2,708.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,815.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,407.60
|
| Rate for Payer: Galaxy Health WC |
$5,116.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,611.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,417.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,014.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,293.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,203.80
|
| Rate for Payer: Multiplan Commercial |
$4,514.25
|
| Rate for Payer: Networks By Design Commercial |
$3,912.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,116.15
|
|
|
HC CT TSPINE W W/O CONTRAST
|
Facility
|
OP
|
$3,534.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
909201966
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,180.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,817.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,087.89
|
| Rate for Payer: Blue Distinction Transplant |
$2,120.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,184.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,717.52
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,590.30
|
| Rate for Payer: Cash Price |
$1,590.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,827.20
|
| Rate for Payer: Cigna of CA HMO |
$2,261.76
|
| Rate for Payer: Cigna of CA PPO |
$2,615.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,003.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,120.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,180.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,650.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,357.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$2,650.50
|
| Rate for Payer: Networks By Design Commercial |
$2,297.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,003.90
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,120.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,120.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| Rate for Payer: United Healthcare All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT UPPER EXT W CONT
|
Facility
|
IP
|
$5,356.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
909201955
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,071.20 |
| Max. Negotiated Rate |
$4,820.40 |
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,284.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,142.40
|
| Rate for Payer: Galaxy Health WC |
$4,552.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,213.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,820.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,572.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,040.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,071.20
|
| Rate for Payer: Multiplan Commercial |
$4,017.00
|
| Rate for Payer: Networks By Design Commercial |
$3,481.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,552.60
|
|
|
HC CT UPPER EXT W CONT
|
Facility
|
OP
|
$2,771.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
909201955
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$373.86 |
| Max. Negotiated Rate |
$2,493.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,220.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,637.11
|
| Rate for Payer: Blue Distinction Transplant |
$1,662.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,712.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,346.71
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$1,246.95
|
| Rate for Payer: Cash Price |
$1,246.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,216.80
|
| Rate for Payer: Cigna of CA HMO |
$1,773.44
|
| Rate for Payer: Cigna of CA PPO |
$2,050.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$2,355.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,493.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,078.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$2,078.25
|
| Rate for Payer: Networks By Design Commercial |
$1,801.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,355.35
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,662.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,662.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CT UPPER EXT W/WO CONT
|
Facility
|
OP
|
$3,236.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
909201956
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,912.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,531.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,911.83
|
| Rate for Payer: Blue Distinction Transplant |
$1,941.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,999.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,572.70
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,456.20
|
| Rate for Payer: Cash Price |
$1,456.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,588.80
|
| Rate for Payer: Cigna of CA HMO |
$2,071.04
|
| Rate for Payer: Cigna of CA PPO |
$2,394.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$2,750.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,941.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,912.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,427.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,158.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$2,427.00
|
| Rate for Payer: Networks By Design Commercial |
$2,103.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,750.60
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,941.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,941.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| Rate for Payer: United Healthcare All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT UPPER EXT W/WO CONT
|
Facility
|
IP
|
$5,765.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
909201956
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,153.00 |
| Max. Negotiated Rate |
$5,188.50 |
| Rate for Payer: Cash Price |
$2,594.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,306.00
|
| Rate for Payer: Galaxy Health WC |
$4,900.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,459.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,188.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,845.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,196.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,153.00
|
| Rate for Payer: Multiplan Commercial |
$4,323.75
|
| Rate for Payer: Networks By Design Commercial |
$3,747.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,900.25
|
|
|
HC CT UPPR EXTR WO CONT
|
Facility
|
OP
|
$2,776.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
909201954
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,498.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,026.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,640.06
|
| Rate for Payer: Blue Distinction Transplant |
$1,665.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,349.14
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$1,249.20
|
| Rate for Payer: Cash Price |
$1,249.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,220.80
|
| Rate for Payer: Cigna of CA HMO |
$1,776.64
|
| Rate for Payer: Cigna of CA PPO |
$2,054.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$2,359.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,665.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,498.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,082.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,851.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$2,082.00
|
| Rate for Payer: Networks By Design Commercial |
$1,804.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,359.60
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,665.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,665.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT UPPR EXTR WO CONT
|
Facility
|
IP
|
$4,947.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
909201954
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$989.40 |
| Max. Negotiated Rate |
$4,452.30 |
| Rate for Payer: Cash Price |
$2,226.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,957.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,978.80
|
| Rate for Payer: Galaxy Health WC |
$4,204.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,968.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,452.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,299.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,884.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$989.40
|
| Rate for Payer: Multiplan Commercial |
$3,710.25
|
| Rate for Payer: Networks By Design Commercial |
$3,215.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,204.95
|
|
|
HC CUIRASS SHELL
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
900800900
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,396.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,265.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,358.84
|
| Rate for Payer: Blue Distinction Transplant |
$1,380.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,446.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,124.70
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Media |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,725.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$805.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC CUIRASS SHELL
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
900800900
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC CULTURE AEROBIC ID
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900911554
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC CULTURE AEROBIC ID
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900911554
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.63
|
| Rate for Payer: Blue Distinction Transplant |
$16.20
|
| Rate for Payer: Blue Shield of California Commercial |
$16.69
|
| Rate for Payer: Blue Shield of California EPN |
$13.12
|
| Rate for Payer: Caremore Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Central Health Plan Commercial |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Media |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: InnovAge PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE AEROBIC ID CYSTIC FIBROSIS
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.63
|
| Rate for Payer: Blue Distinction Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.07
|
| Rate for Payer: Caremore Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Media |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: InnovAge PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE AEROBIC ID CYSTIC FIBROSIS
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Cash Price |
$179.55
|
| Rate for Payer: Central Health Plan Commercial |
$319.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$339.15
|
| Rate for Payer: Global Benefits Group Commercial |
$239.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$359.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.80
|
| Rate for Payer: Multiplan Commercial |
$299.25
|
| Rate for Payer: Networks By Design Commercial |
$259.35
|
| Rate for Payer: Prime Health Services Commercial |
$339.15
|
|
|
HC CULTURE ANAEROBIC
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
900911501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.93
|
| Rate for Payer: Blue Distinction Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.07
|
| Rate for Payer: Caremore Medicare Advantage |
$9.47
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.20
|
| Rate for Payer: Dignity Health Media |
$9.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.47
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.47
|
| Rate for Payer: InnovAge PACE Commercial |
$14.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.69
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$10.04
|
| Rate for Payer: Riverside University Health System MISP |
$10.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.67
|
| Rate for Payer: United Healthcare All Other HMO |
$7.67
|
| Rate for Payer: United Healthcare HMO Rider |
$7.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.42
|
| Rate for Payer: Vantage Medical Group Senior |
$9.47
|
|
|
HC CULTURE ANAEROBIC
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
900911501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$71.00 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Central Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.00
|
| Rate for Payer: Galaxy Health WC |
$301.75
|
| Rate for Payer: Global Benefits Group Commercial |
$213.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$319.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.00
|
| Rate for Payer: Multiplan Commercial |
$266.25
|
| Rate for Payer: Networks By Design Commercial |
$230.75
|
| Rate for Payer: Prime Health Services Commercial |
$301.75
|
|
|
HC CULTURE ANAEROBIC IDS RAPID
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900911553
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC CULTURE ANAEROBIC IDS RAPID
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900911553
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.77
|
| Rate for Payer: Blue Distinction Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.07
|
| Rate for Payer: Caremore Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Media |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: InnovAge PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE BACTERIAL AG H INFLU
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC CULTURE BACTERIAL AG H INFLU
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$41.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.52
|
| Rate for Payer: Blue Distinction Transplant |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.03
|
| Rate for Payer: Blue Shield of California EPN |
$6.32
|
| Rate for Payer: Caremore Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Media |
$5.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC CULTURE BACTERIAL AG N MENING
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911713
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$41.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.52
|
| Rate for Payer: Blue Distinction Transplant |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.03
|
| Rate for Payer: Blue Shield of California EPN |
$6.32
|
| Rate for Payer: Caremore Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Media |
$5.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC CULTURE BACTERIAL AG N MENING
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911713
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
