|
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: 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 Permanente of CA Commercial/Self Funded |
$2,359.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,347.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,189.40
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,906.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,088.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,769.10
|
| 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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$571.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,286.10
|
| 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 |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| 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: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$248.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,906.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| 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 |
$1,131.20
|
| 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 |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,714.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
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 |
$28.31 |
| Max. Negotiated Rate |
$1,092.60 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$737.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.31
|
| Rate for Payer: Blue Shield of California Commercial |
$736.90
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,031.90
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$910.50
|
| Rate for Payer: Networks By Design Commercial |
$789.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.90
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$809.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$751.47
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$160.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.18
|
| 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 LUMBAR SPINE LIMITED
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.31 |
| Max. Negotiated Rate |
$221.60 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.31
|
| Rate for Payer: Blue Shield of California Commercial |
$146.29
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
| Rate for Payer: Networks By Design Commercial |
$156.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$2,914.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,664.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,705.03
|
| 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
|
|
|
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 |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$874.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$2,115.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,566.50
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| 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: 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: InnovAge PACE Commercial |
$2,185.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,914.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,705.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,059.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| 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 SPINE BEND ONLY/4 VIEWS
|
Facility
|
IP
|
$1,439.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
909001318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.80 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Adventist Health Commercial |
$287.80
|
| Rate for Payer: Cash Price |
$647.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$575.60
|
| Rate for Payer: EPIC Health Plan Senior |
$575.60
|
| Rate for Payer: Galaxy Health WC |
$1,223.15
|
| Rate for Payer: Global Benefits Group Commercial |
$863.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,295.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$959.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$890.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.80
|
| Rate for Payer: Multiplan Commercial |
$1,079.25
|
| Rate for Payer: Networks By Design Commercial |
$935.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,223.15
|
|
|
HC LUM SPINE BEND ONLY/4 VIEWS
|
Facility
|
OP
|
$1,439.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
909001318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Adventist Health Commercial |
$287.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$873.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.70
|
| Rate for Payer: Blue Shield of California Commercial |
$873.47
|
| Rate for Payer: Blue Shield of California EPN |
$571.28
|
| Rate for Payer: Cash Price |
$647.55
|
| Rate for Payer: Cash Price |
$647.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,151.20
|
| Rate for Payer: Cigna of CA HMO |
$920.96
|
| Rate for Payer: Cigna of CA PPO |
$1,064.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,223.15
|
| Rate for Payer: Global Benefits Group Commercial |
$863.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,295.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$959.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,079.25
|
| Rate for Payer: Networks By Design Commercial |
$935.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,223.15
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$863.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$863.40
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC LUM SPINE COMP W/BENDING VIEWS
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
909001316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.99 |
| Max. Negotiated Rate |
$2,001.60 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,350.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$246.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,349.97
|
| Rate for Payer: Blue Shield of California EPN |
$882.93
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,779.20
|
| Rate for Payer: Cigna of CA HMO |
$1,423.36
|
| Rate for Payer: Cigna of CA PPO |
$1,645.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,001.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$91.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC LUM SPINE COMP W/BENDING VIEWS
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
909001316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$2,001.60 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,779.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,001.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.80
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
|
|
HC LUM SPINE W/OBLIQUES
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
909001317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Adventist Health Commercial |
$320.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$640.00
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,440.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$990.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.00
|
| Rate for Payer: Multiplan Commercial |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$1,040.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
|
|
HC LUM SPINE W/OBLIQUES
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
909001317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.67 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Adventist Health Commercial |
$320.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$971.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$190.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.67
|
| Rate for Payer: Blue Shield of California Commercial |
$971.20
|
| Rate for Payer: Blue Shield of California EPN |
$635.20
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,280.00
|
| Rate for Payer: Cigna of CA HMO |
$1,024.00
|
| Rate for Payer: Cigna of CA PPO |
$1,184.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,440.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$75.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$1,040.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$960.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$960.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC LUNG BIOPSY, PERCUTANEOUS
|
Facility
|
IP
|
$4,488.00
|
|
|
Service Code
|
CPT 32405
|
| Hospital Charge Code |
909000124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$897.60 |
| Max. Negotiated Rate |
$4,039.20 |
| Rate for Payer: Adventist Health Commercial |
$897.60
|
| Rate for Payer: Cash Price |
$2,019.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,590.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,795.20
|
| Rate for Payer: Galaxy Health WC |
$3,814.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,039.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,993.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,709.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,778.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.60
|
| Rate for Payer: Multiplan Commercial |
$3,366.00
|
| Rate for Payer: Networks By Design Commercial |
$2,917.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,814.80
|
|
|
HC LUNG BIOPSY, PERCUTANEOUS
|
Facility
|
OP
|
$4,488.00
|
|
|
Service Code
|
CPT 32405
|
| Hospital Charge Code |
909000124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$897.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$897.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,468.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,366.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,173.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,635.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,019.60
|
| Rate for Payer: Cash Price |
$2,019.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,590.40
|
| Rate for Payer: Cigna of CA HMO |
$2,872.32
|
| Rate for Payer: Cigna of CA PPO |
$3,321.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,814.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,814.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,795.20
|
| Rate for Payer: Galaxy Health WC |
$3,814.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,039.20
|
| Rate for Payer: InnovAge PACE Commercial |
$2,244.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,993.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,709.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,778.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,141.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,141.60
|
| Rate for Payer: Multiplan Commercial |
$3,366.00
|
| Rate for Payer: Networks By Design Commercial |
$2,917.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,814.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,795.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,692.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,244.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,244.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,244.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,244.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,814.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,814.80
|
|
|
HC LUNG DIFFER PERF & VENTILATION
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
909301402
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$321.39 |
| Max. Negotiated Rate |
$3,654.00 |
| Rate for Payer: Adventist Health Commercial |
$812.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$683.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,465.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,583.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2,464.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,611.82
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,248.00
|
| Rate for Payer: Cigna of CA HMO |
$2,598.40
|
| Rate for Payer: Cigna of CA PPO |
$3,004.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$3,451.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,436.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,654.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$466.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,025.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,708.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$916.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$3,045.00
|
| Rate for Payer: Networks By Design Commercial |
$2,639.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$683.93
|
| Rate for Payer: Prime Health Services Commercial |
$3,451.00
|
| Rate for Payer: Prime Health Services Medicare |
$724.97
|
| Rate for Payer: Riverside University Health System MISP |
$752.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,436.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,436.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$809.82
|
| Rate for Payer: United Healthcare All Other HMO |
$809.82
|
| Rate for Payer: United Healthcare HMO Rider |
$809.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$809.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC LUNG DIFFER PERF & VENTILATION
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
909301402
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$812.00 |
| Max. Negotiated Rate |
$3,654.00 |
| Rate for Payer: Adventist Health Commercial |
$812.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,248.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,624.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,624.00
|
| Rate for Payer: Galaxy Health WC |
$3,451.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,436.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,654.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,708.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,546.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,513.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.00
|
| Rate for Payer: Multiplan Commercial |
$3,045.00
|
| Rate for Payer: Networks By Design Commercial |
$2,639.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,451.00
|
|
|
HC LUPUS SCREEN PTT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900912006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC LUPUS SCREEN PTT
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900912006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.87
|
| Rate for Payer: Blue Shield of California Commercial |
$36.42
|
| Rate for Payer: Blue Shield of California EPN |
$23.82
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Senior |
$6.01
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: InnovAge PACE Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.01
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Medicare |
$6.37
|
| Rate for Payer: Riverside University Health System MISP |
$6.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC LUTEINIZING HORMON
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
900910886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$134.74 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$134.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.34
|
| Rate for Payer: Blue Shield of California Commercial |
$55.84
|
| Rate for Payer: Blue Shield of California EPN |
$36.52
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Central Health Plan Commercial |
$73.60
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.52
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.52
|
| Rate for Payer: InnovAge PACE Commercial |
$27.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.82
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.52
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Prime Health Services Medicare |
$19.63
|
| Rate for Payer: Riverside University Health System MISP |
$20.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
|
|
HC LUTEINIZING HORMON
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
900910886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Central Health Plan Commercial |
$241.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.80
|
| Rate for Payer: EPIC Health Plan Senior |
$120.80
|
| Rate for Payer: Galaxy Health WC |
$256.70
|
| Rate for Payer: Global Benefits Group Commercial |
$181.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$271.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$186.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.40
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: Networks By Design Commercial |
$196.30
|
| Rate for Payer: Prime Health Services Commercial |
$256.70
|
|
|
HC LVN (15 MINS)
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
903400743
|
|
Hospital Revenue Code
|
580
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.08
|
| Rate for Payer: Blue Shield of California Commercial |
$25.05
|
| Rate for Payer: Blue Shield of California EPN |
$16.36
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: InnovAge PACE Commercial |
$20.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Riverside University Health System MISP |
$16.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20.50
|
| Rate for Payer: United Healthcare HMO Rider |
$20.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC LVN (15 MINS)
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
903400743
|
|
Hospital Revenue Code
|
580
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
