|
HC LSO SAG RIGID ANT/POST PANEL S1-T9 CUSTOM
|
Facility
|
IP
|
$3,047.00
|
|
|
Service Code
|
CPT L0632
|
| Hospital Charge Code |
915350632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$609.40 |
| Max. Negotiated Rate |
$2,742.30 |
| Rate for Payer: Adventist Health Commercial |
$609.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,443.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,535.69
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,437.60
|
| Rate for Payer: Cigna of CA HMO |
$2,132.90
|
| Rate for Payer: Cigna of CA PPO |
$2,132.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,132.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.80
|
| Rate for Payer: Galaxy Health WC |
$2,589.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,828.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,742.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,934.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,797.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.40
|
| Rate for Payer: Multiplan Commercial |
$2,285.25
|
| Rate for Payer: Networks By Design Commercial |
$1,980.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,143.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$997.89
|
|
|
HC LSO S/C SHELL/PANEL CUSTOM
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
CPT L0640
|
| Hospital Charge Code |
915350640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$1,479.60 |
| Rate for Payer: Adventist Health Commercial |
$328.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,318.49
|
| Rate for Payer: Blue Shield of California EPN |
$828.58
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Cigna of CA HMO |
$1,150.80
|
| Rate for Payer: Cigna of CA PPO |
$1,150.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,150.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: EPIC Health Plan Senior |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$969.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$1,068.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.99
|
| Rate for Payer: United Healthcare All Other HMO |
$600.55
|
| Rate for Payer: United Healthcare HMO Rider |
$587.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$538.41
|
|
|
HC LSO S/C SHELL/PANEL CUSTOM
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT L0640
|
| Hospital Charge Code |
915350640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$538.41 |
| Max. Negotiated Rate |
$1,479.60 |
| Rate for Payer: Adventist Health Commercial |
$674.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$904.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,233.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$956.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,318.49
|
| Rate for Payer: Blue Shield of California EPN |
$828.58
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Cigna of CA HMO |
$1,150.80
|
| Rate for Payer: Cigna of CA PPO |
$1,150.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,397.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,397.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,150.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: EPIC Health Plan Senior |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,131.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,249.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$969.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,150.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$822.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: Riverside University Health System MISP |
$657.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$986.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.99
|
| Rate for Payer: United Healthcare All Other HMO |
$600.55
|
| Rate for Payer: United Healthcare HMO Rider |
$587.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$538.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,397.40
|
|
|
HC LSO S/C SHELL/PANEL CUSTOM
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT L0640
|
| Hospital Charge Code |
905350640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$538.41 |
| Max. Negotiated Rate |
$1,479.60 |
| Rate for Payer: Adventist Health Commercial |
$674.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$904.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,233.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$956.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,318.49
|
| Rate for Payer: Blue Shield of California EPN |
$828.58
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Cigna of CA HMO |
$1,150.80
|
| Rate for Payer: Cigna of CA PPO |
$1,150.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,397.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,397.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,150.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: EPIC Health Plan Senior |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,131.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,249.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$969.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,150.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$822.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: Riverside University Health System MISP |
$657.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$986.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.99
|
| Rate for Payer: United Healthcare All Other HMO |
$600.55
|
| Rate for Payer: United Healthcare HMO Rider |
$587.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$538.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,397.40
|
|
|
HC LSO S/C SHELL/PANEL CUSTOM
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
CPT L0640
|
| Hospital Charge Code |
905350640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$1,479.60 |
| Rate for Payer: Adventist Health Commercial |
$328.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,318.49
|
| Rate for Payer: Blue Shield of California EPN |
$828.58
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Cigna of CA HMO |
$1,150.80
|
| Rate for Payer: Cigna of CA PPO |
$1,150.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,150.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: EPIC Health Plan Senior |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$969.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$1,068.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.99
|
| Rate for Payer: United Healthcare All Other HMO |
$600.55
|
| Rate for Payer: United Healthcare HMO Rider |
$587.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$538.41
|
|
|
HC LSO S/C SHELL/PANEL PREFAB
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
CPT L0639
|
| Hospital Charge Code |
905350639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$382.00 |
| Max. Negotiated Rate |
$1,719.00 |
| Rate for Payer: Adventist Health Commercial |
$382.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,531.82
|
| Rate for Payer: Blue Shield of California EPN |
$962.64
|
| Rate for Payer: Cash Price |
$859.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,528.00
|
| Rate for Payer: Cigna of CA HMO |
$1,337.00
|
| Rate for Payer: Cigna of CA PPO |
$1,337.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,337.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$764.00
|
| Rate for Payer: EPIC Health Plan Senior |
$764.00
|
| Rate for Payer: Galaxy Health WC |
$1,623.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,146.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,719.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,212.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,126.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.00
|
| Rate for Payer: Multiplan Commercial |
$1,432.50
|
| Rate for Payer: Networks By Design Commercial |
$1,241.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,623.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$716.82
|
| Rate for Payer: United Healthcare All Other HMO |
$697.72
|
| Rate for Payer: United Healthcare HMO Rider |
$682.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$625.52
|
|
|
HC LSO S/C SHELL/PANEL PREFAB
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
CPT L0639
|
| Hospital Charge Code |
905350639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$625.52 |
| Max. Negotiated Rate |
$1,719.00 |
| Rate for Payer: Adventist Health Commercial |
$783.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,623.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,050.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,432.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,111.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,531.82
|
| Rate for Payer: Blue Shield of California EPN |
$962.64
|
| Rate for Payer: Cash Price |
$859.50
|
| Rate for Payer: Cash Price |
$859.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,528.00
|
| Rate for Payer: Cigna of CA HMO |
$1,337.00
|
| Rate for Payer: Cigna of CA PPO |
$1,337.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,623.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,623.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,623.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,337.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$764.00
|
| Rate for Payer: EPIC Health Plan Senior |
$764.00
|
| Rate for Payer: Galaxy Health WC |
$1,623.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,146.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,719.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,308.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,212.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,444.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,126.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,337.00
|
| Rate for Payer: Multiplan Commercial |
$1,432.50
|
| Rate for Payer: Networks By Design Commercial |
$955.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,623.50
|
| Rate for Payer: Riverside University Health System MISP |
$764.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,146.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,146.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$716.82
|
| Rate for Payer: United Healthcare All Other HMO |
$697.72
|
| Rate for Payer: United Healthcare HMO Rider |
$682.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$625.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,623.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,623.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,623.50
|
|
|
HC LTD TAGGED WBC SCAN LIMITED
|
Facility
|
OP
|
$2,854.00
|
|
|
Service Code
|
CPT 78805
|
| Hospital Charge Code |
909301442
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$570.80 |
| Max. Negotiated Rate |
$2,568.60 |
| Rate for Payer: Adventist Health Commercial |
$570.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,733.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,425.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,569.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,140.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$701.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,660.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,798.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,133.04
|
| Rate for Payer: Cash Price |
$1,284.30
|
| Rate for Payer: Cash Price |
$1,284.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,283.20
|
| Rate for Payer: Cigna of CA HMO |
$1,826.56
|
| Rate for Payer: Cigna of CA PPO |
$2,111.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,425.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,425.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,425.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,997.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,141.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,141.60
|
| Rate for Payer: Galaxy Health WC |
$2,425.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,712.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,568.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,812.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,036.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,683.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,997.80
|
| Rate for Payer: Multiplan Commercial |
$2,140.50
|
| Rate for Payer: Networks By Design Commercial |
$1,855.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,425.90
|
| Rate for Payer: Riverside University Health System MISP |
$1,141.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,712.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,712.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,427.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,427.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,427.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,427.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,425.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,425.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,425.90
|
|
|
HC LTD TAGGED WBC SCAN LIMITED
|
Facility
|
IP
|
$2,854.00
|
|
|
Service Code
|
CPT 78805
|
| Hospital Charge Code |
909301442
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$570.80 |
| Max. Negotiated Rate |
$2,568.60 |
| Rate for Payer: Adventist Health Commercial |
$570.80
|
| Rate for Payer: Cash Price |
$1,284.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,283.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,997.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,141.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,141.60
|
| Rate for Payer: Galaxy Health WC |
$2,425.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,712.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,568.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,812.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,683.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.80
|
| Rate for Payer: Multiplan Commercial |
$2,140.50
|
| Rate for Payer: Networks By Design Commercial |
$1,855.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,425.90
|
|
|
HC LUMBAR DISCOGRAPHY, 1 LEVEL
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
909000183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$157.60 |
| Max. Negotiated Rate |
$709.20 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Central Health Plan Commercial |
$630.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$551.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.20
|
| Rate for Payer: EPIC Health Plan Senior |
$315.20
|
| Rate for Payer: Galaxy Health WC |
$669.80
|
| Rate for Payer: Global Benefits Group Commercial |
$472.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$709.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$500.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.60
|
| Rate for Payer: Multiplan Commercial |
$591.00
|
| Rate for Payer: Networks By Design Commercial |
$512.20
|
| Rate for Payer: Prime Health Services Commercial |
$669.80
|
|
|
HC LUMBAR DISCOGRAPHY, 1 LEVEL
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
909000183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$157.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$669.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$433.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$591.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Central Health Plan Commercial |
$630.40
|
| Rate for Payer: Cigna of CA HMO |
$504.32
|
| Rate for Payer: Cigna of CA PPO |
$583.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$669.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$669.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$669.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$551.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.20
|
| Rate for Payer: EPIC Health Plan Senior |
$315.20
|
| Rate for Payer: Galaxy Health WC |
$669.80
|
| Rate for Payer: Global Benefits Group Commercial |
$472.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$709.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$219.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$500.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$242.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$551.60
|
| Rate for Payer: Multiplan Commercial |
$591.00
|
| Rate for Payer: Networks By Design Commercial |
$512.20
|
| Rate for Payer: Prime Health Services Commercial |
$669.80
|
| Rate for Payer: Riverside University Health System MISP |
$315.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$669.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$669.80
|
| Rate for Payer: Vantage Medical Group Senior |
$669.80
|
|
|
HC LUMBAR PUNCTURE FOR MYELOGR
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
909000181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Central Health Plan Commercial |
$552.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$483.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.00
|
| Rate for Payer: EPIC Health Plan Senior |
$276.00
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$438.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$407.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
|
|
HC LUMBAR PUNCTURE FOR MYELOGR
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
909000181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$586.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$379.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$517.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Central Health Plan Commercial |
$552.00
|
| Rate for Payer: Cigna of CA HMO |
$441.60
|
| Rate for Payer: Cigna of CA PPO |
$510.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$586.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$586.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$586.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$483.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.00
|
| Rate for Payer: EPIC Health Plan Senior |
$276.00
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$438.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$407.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$483.00
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
| Rate for Payer: Riverside University Health System MISP |
$276.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$414.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$345.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$586.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$586.50
|
| Rate for Payer: Vantage Medical Group Senior |
$586.50
|
|
|
HC LUMBAR/SACRAL FACET INJ 3RD EA
|
Facility
|
IP
|
$1,939.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
909020044
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$387.80 |
| Max. Negotiated Rate |
$1,745.10 |
| Rate for Payer: Adventist Health Commercial |
$387.80
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,551.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,357.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$775.60
|
| Rate for Payer: EPIC Health Plan Senior |
$775.60
|
| Rate for Payer: Galaxy Health WC |
$1,648.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,163.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,745.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,231.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,144.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.80
|
| Rate for Payer: Multiplan Commercial |
$1,454.25
|
| Rate for Payer: Networks By Design Commercial |
$1,260.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,648.15
|
|
|
HC LUMBAR/SACRAL FACET INJ 3RD EA
|
Facility
|
OP
|
$1,939.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
909020044
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.43 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$387.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,648.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,066.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,454.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,551.20
|
| Rate for Payer: Cigna of CA HMO |
$1,240.96
|
| Rate for Payer: Cigna of CA PPO |
$1,434.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,648.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,648.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,648.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,357.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$775.60
|
| Rate for Payer: EPIC Health Plan Senior |
$775.60
|
| Rate for Payer: Galaxy Health WC |
$1,648.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,163.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,745.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$127.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,231.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,144.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,357.30
|
| Rate for Payer: Multiplan Commercial |
$1,454.25
|
| Rate for Payer: Networks By Design Commercial |
$1,260.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,648.15
|
| Rate for Payer: Riverside University Health System MISP |
$775.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,163.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,648.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,648.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,648.15
|
|
|
HC LUMBAR/SACRAL FACET INJECT/ADD
|
Facility
|
OP
|
$3,537.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
909000186
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$707.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,006.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,945.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,652.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,829.60
|
| Rate for Payer: Cigna of CA HMO |
$2,263.68
|
| Rate for Payer: Cigna of CA PPO |
$2,617.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,006.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,006.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,006.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,475.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,414.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,414.80
|
| Rate for Payer: Galaxy Health WC |
$3,006.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,122.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,183.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,245.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,086.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,475.90
|
| Rate for Payer: Multiplan Commercial |
$2,652.75
|
| Rate for Payer: Networks By Design Commercial |
$2,299.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,006.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,414.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,122.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,768.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,006.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,006.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,006.45
|
|
|
HC LUMBAR/SACRAL FACET INJECT/ADD
|
Facility
|
IP
|
$3,537.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
909000186
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$707.40 |
| Max. Negotiated Rate |
$3,183.30 |
| Rate for Payer: Adventist Health Commercial |
$707.40
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,829.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,475.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,414.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,414.80
|
| Rate for Payer: Galaxy Health WC |
$3,006.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,122.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,183.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,245.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,086.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.40
|
| Rate for Payer: Multiplan Commercial |
$2,652.75
|
| Rate for Payer: Networks By Design Commercial |
$2,299.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,006.45
|
|
|
HC LUMBAR/SACRAL FACET INJECT/INT
|
Facility
|
IP
|
$2,858.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
909000185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$571.60 |
| Max. Negotiated Rate |
$2,572.20 |
| Rate for Payer: Adventist Health Commercial |
$571.60
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,286.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,000.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,143.20
|
| Rate for Payer: Galaxy Health WC |
$2,429.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,572.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,814.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,686.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.60
|
| Rate for Payer: Multiplan Commercial |
$2,143.50
|
| Rate for Payer: Networks By Design Commercial |
$1,857.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,429.30
|
|
|
HC LUMBAR/SACRAL FACET INJECT/INT
|
Facility
|
OP
|
$2,858.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
909000185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$248.45 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$571.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,137.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,286.40
|
| Rate for Payer: Cigna of CA HMO |
$1,829.12
|
| Rate for Payer: Cigna of CA PPO |
$2,114.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,000.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$2,429.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,572.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$248.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,814.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$274.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,143.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,857.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,429.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,714.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,429.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC LUMBAR SPINE AP AND LATERAL
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.10 |
| Max. Negotiated Rate |
$1,092.60 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.92
|
| Rate for Payer: Blue Shield of California Commercial |
$764.82
|
| Rate for Payer: Blue Shield of California EPN |
$481.96
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Central Health Plan Commercial |
$971.20
|
| Rate for Payer: Cigna of CA HMO |
$776.96
|
| Rate for Payer: Cigna of CA PPO |
$898.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,031.90
|
| Rate for Payer: Global Benefits Group Commercial |
$728.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,092.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$770.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$910.50
|
| Rate for Payer: Networks By Design Commercial |
$789.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.90
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$728.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$728.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC LUMBAR SPINE AP AND LATERAL
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.80 |
| Max. Negotiated Rate |
$1,092.60 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Central Health Plan Commercial |
$971.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.60
|
| Rate for Payer: EPIC Health Plan Senior |
$485.60
|
| Rate for Payer: Galaxy Health WC |
$1,031.90
|
| Rate for Payer: Global Benefits Group Commercial |
$728.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,092.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$770.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$716.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.80
|
| Rate for Payer: Multiplan Commercial |
$910.50
|
| Rate for Payer: Networks By Design Commercial |
$789.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.90
|
|
|
HC LUMBAR SPINE LIMITED
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$221.86 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.92
|
| Rate for Payer: Blue Shield of California Commercial |
$151.83
|
| Rate for Payer: Blue Shield of California EPN |
$95.68
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Central Health Plan Commercial |
$192.80
|
| Rate for Payer: Cigna of CA HMO |
$154.24
|
| Rate for Payer: Cigna of CA PPO |
$178.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$204.85
|
| Rate for Payer: Global Benefits Group Commercial |
$144.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
| Rate for Payer: Networks By Design Commercial |
$156.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.60
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC LUMBAR SPINE LIMITED
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$216.90 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Central Health Plan Commercial |
$192.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.40
|
| Rate for Payer: EPIC Health Plan Senior |
$96.40
|
| Rate for Payer: Galaxy Health WC |
$204.85
|
| Rate for Payer: Global Benefits Group Commercial |
$144.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.20
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
| Rate for Payer: Networks By Design Commercial |
$156.65
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
|
|
HC LUM/SAC ABL EA ADD LEVEL
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909000263
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.37 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$874.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,403.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,277.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,496.00
|
| Rate for Payer: Cigna of CA HMO |
$2,796.80
|
| Rate for Payer: Cigna of CA PPO |
$3,233.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,714.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,714.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,059.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,748.00
|
| Rate for Payer: Galaxy Health WC |
$3,714.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,622.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,933.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,774.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,578.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,059.00
|
| Rate for Payer: Multiplan Commercial |
$3,277.50
|
| Rate for Payer: Networks By Design Commercial |
$2,840.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,714.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,748.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,622.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,185.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,714.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,714.50
|
|
|
HC LUM/SAC ABL EA ADD LEVEL
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909000263
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$3,933.00 |
| Rate for Payer: Adventist Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,496.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,059.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,748.00
|
| Rate for Payer: Galaxy Health WC |
$3,714.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,622.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,933.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,774.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,578.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.00
|
| Rate for Payer: Multiplan Commercial |
$3,277.50
|
| Rate for Payer: Networks By Design Commercial |
$2,840.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,714.50
|
|
