|
HC MUMPS AB
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913533
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Central Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.60
|
| Rate for Payer: EPIC Health Plan Senior |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
|
|
HC MUMPS ANTIBODY
|
Facility
|
OP
|
$128.12
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913663
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$115.31 |
| Rate for Payer: Adventist Health Commercial |
$25.62
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.47
|
| Rate for Payer: Blue Shield of California Commercial |
$77.77
|
| Rate for Payer: Blue Shield of California EPN |
$50.86
|
| Rate for Payer: Cash Price |
$70.47
|
| Rate for Payer: Cash Price |
$70.47
|
| Rate for Payer: Central Health Plan Commercial |
$102.50
|
| Rate for Payer: Cigna of CA HMO |
$82.00
|
| Rate for Payer: Cigna of CA PPO |
$94.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.05
|
| Rate for Payer: Galaxy Health WC |
$108.90
|
| Rate for Payer: Global Benefits Group Commercial |
$76.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: InnovAge PACE Commercial |
$19.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$96.09
|
| Rate for Payer: Networks By Design Commercial |
$83.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.05
|
| Rate for Payer: Prime Health Services Commercial |
$108.90
|
| Rate for Payer: Prime Health Services Medicare |
$13.83
|
| Rate for Payer: Riverside University Health System MISP |
$14.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.57
|
| Rate for Payer: United Healthcare All Other HMO |
$10.57
|
| Rate for Payer: United Healthcare HMO Rider |
$10.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC MUMPS ANTIBODY
|
Facility
|
IP
|
$128.12
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913663
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$115.31 |
| Rate for Payer: Adventist Health Commercial |
$25.62
|
| Rate for Payer: Cash Price |
$70.47
|
| Rate for Payer: Central Health Plan Commercial |
$102.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.25
|
| Rate for Payer: EPIC Health Plan Senior |
$51.25
|
| Rate for Payer: Galaxy Health WC |
$108.90
|
| Rate for Payer: Global Benefits Group Commercial |
$76.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.62
|
| Rate for Payer: Multiplan Commercial |
$96.09
|
| Rate for Payer: Networks By Design Commercial |
$83.28
|
| Rate for Payer: Prime Health Services Commercial |
$108.90
|
|
|
HC MUSCLE BIOPSY, PERCUTANEOUS
|
Facility
|
OP
|
$3,779.00
|
|
|
Service Code
|
CPT 20206
|
| Hospital Charge Code |
909000105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.35 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$755.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| 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 |
$3,280.13
|
| 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 |
$2,078.45
|
| Rate for Payer: Cash Price |
$2,078.45
|
| Rate for Payer: Cash Price |
$2,078.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,023.20
|
| Rate for Payer: Cigna of CA HMO |
$2,418.56
|
| Rate for Payer: Cigna of CA PPO |
$2,796.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$3,212.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,267.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,401.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,520.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$755.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$2,834.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,456.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$3,212.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,267.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC MUSCLE BIOPSY, PERCUTANEOUS
|
Facility
|
IP
|
$3,779.00
|
|
|
Service Code
|
CPT 20206
|
| Hospital Charge Code |
909000105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$755.80 |
| Max. Negotiated Rate |
$3,401.10 |
| Rate for Payer: Adventist Health Commercial |
$755.80
|
| Rate for Payer: Cash Price |
$2,078.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,023.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,511.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,511.60
|
| Rate for Payer: Galaxy Health WC |
$3,212.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,267.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,401.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,520.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,439.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,339.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$755.80
|
| Rate for Payer: Multiplan Commercial |
$2,834.25
|
| Rate for Payer: Networks By Design Commercial |
$2,456.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,212.15
|
|
|
HC MUSCLE TEST COMPUTER 30MIN OT
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 97752
|
| Hospital Charge Code |
903207752
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$166.40
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$277.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$257.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$270.40
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
|
|
HC MUSCLE TEST COMPUTER 30MIN OT
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 97752
|
| Hospital Charge Code |
903207752
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$158.50 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$170.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$252.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: Cigna of CA HMO |
$266.24
|
| Rate for Payer: Cigna of CA PPO |
$307.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$353.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$166.40
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: InnovAge PACE Commercial |
$208.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$277.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$257.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$270.40
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
| Rate for Payer: Riverside University Health System MISP |
$166.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$249.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.60
|
| Rate for Payer: Vantage Medical Group Senior |
$353.60
|
|
|
HC MUSCLE TEST MANUAL W RPT
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
900895831
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
|
|
HC MUSCLE TEST MANUAL W RPT
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
900895831
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$1,021.00 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$264.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$210.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.48
|
| Rate for Payer: Blue Shield of California Commercial |
$264.05
|
| Rate for Payer: Blue Shield of California EPN |
$172.69
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: Cigna of CA HMO |
$278.40
|
| Rate for Payer: Cigna of CA PPO |
$321.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: InnovAge PACE Commercial |
$217.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$304.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Riverside University Health System MISP |
$174.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC MYELOGRAM, CERVICAL
|
Facility
|
OP
|
$2,872.00
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
909001363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.59 |
| Max. Negotiated Rate |
$2,584.80 |
| Rate for Payer: Adventist Health Commercial |
$574.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,003.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,744.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$982.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,743.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,140.18
|
| Rate for Payer: Cash Price |
$1,579.60
|
| Rate for Payer: Cash Price |
$1,579.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,297.60
|
| Rate for Payer: Cigna of CA HMO |
$1,838.08
|
| Rate for Payer: Cigna of CA PPO |
$2,125.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$2,441.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,723.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,584.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,505.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,915.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$2,154.00
|
| Rate for Payer: Networks By Design Commercial |
$1,866.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,441.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.08
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,723.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,723.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,265.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,265.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,265.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAM, CERVICAL
|
Facility
|
IP
|
$2,872.00
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
909001363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.40 |
| Max. Negotiated Rate |
$2,584.80 |
| Rate for Payer: Adventist Health Commercial |
$574.40
|
| Rate for Payer: Cash Price |
$1,579.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,297.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,148.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,148.80
|
| Rate for Payer: Galaxy Health WC |
$2,441.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,723.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,584.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,915.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,094.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.40
|
| Rate for Payer: Multiplan Commercial |
$2,154.00
|
| Rate for Payer: Networks By Design Commercial |
$1,866.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,441.20
|
|
|
HC MYELOGRAM, COMPLETE
|
Facility
|
IP
|
$3,162.00
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
909001364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$632.40 |
| Max. Negotiated Rate |
$2,845.80 |
| Rate for Payer: Adventist Health Commercial |
$632.40
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,529.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,264.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,264.80
|
| Rate for Payer: Galaxy Health WC |
$2,687.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,897.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,845.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,109.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,204.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,957.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.40
|
| Rate for Payer: Multiplan Commercial |
$2,371.50
|
| Rate for Payer: Networks By Design Commercial |
$2,055.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,687.70
|
|
|
HC MYELOGRAM, COMPLETE
|
Facility
|
OP
|
$3,162.00
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
909001364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.22 |
| Max. Negotiated Rate |
$2,845.80 |
| Rate for Payer: Adventist Health Commercial |
$632.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,003.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,920.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,263.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$256.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,919.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,255.31
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,529.60
|
| Rate for Payer: Cigna of CA HMO |
$2,023.68
|
| Rate for Payer: Cigna of CA PPO |
$2,339.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$2,687.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,897.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,845.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$194.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,505.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,109.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$2,371.50
|
| Rate for Payer: Networks By Design Commercial |
$2,055.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,687.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.08
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,897.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,897.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,265.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,265.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,265.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY LUMBAR INJECT 2 OR GT LVLS
|
Facility
|
OP
|
$3,621.00
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
909062305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$724.20 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,003.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$1,599.45
|
| 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 |
$1,991.55
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,896.80
|
| Rate for Payer: Cigna of CA HMO |
$2,317.44
|
| Rate for Payer: Cigna of CA PPO |
$2,679.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$3,077.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,172.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,258.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,505.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,415.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
| Rate for Payer: Multiplan WC |
$1,599.45
|
| Rate for Payer: Networks By Design Commercial |
$2,353.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Preferred Health Network WC |
$1,632.09
|
| Rate for Payer: Prime Health Services Commercial |
$3,077.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.08
|
| Rate for Payer: Prime Health Services WC |
$1,583.13
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,172.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY LUMBAR INJECT 2 OR GT LVLS
|
Facility
|
IP
|
$3,621.00
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
909062305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$724.20 |
| Max. Negotiated Rate |
$3,258.90 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,896.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,448.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,448.40
|
| Rate for Payer: Galaxy Health WC |
$3,077.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,172.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,258.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,415.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,379.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,241.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.20
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
| Rate for Payer: Networks By Design Commercial |
$2,353.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,077.85
|
|
|
HC MYELOGRAPHY LUMBAR INJECT C-SPINE
|
Facility
|
OP
|
$3,621.00
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
909062302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$186.34 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,003.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$1,599.45
|
| 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 |
$1,991.55
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,896.80
|
| Rate for Payer: Cigna of CA HMO |
$2,317.44
|
| Rate for Payer: Cigna of CA PPO |
$2,679.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$3,077.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,172.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,258.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$186.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,505.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,415.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
| Rate for Payer: Multiplan WC |
$1,599.45
|
| Rate for Payer: Networks By Design Commercial |
$2,353.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Preferred Health Network WC |
$1,632.09
|
| Rate for Payer: Prime Health Services Commercial |
$3,077.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.08
|
| Rate for Payer: Prime Health Services WC |
$1,583.13
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,172.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY LUMBAR INJECT C-SPINE
|
Facility
|
IP
|
$3,621.00
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
909062302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$724.20 |
| Max. Negotiated Rate |
$3,258.90 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,896.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,448.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,448.40
|
| Rate for Payer: Galaxy Health WC |
$3,077.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,172.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,258.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,415.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,379.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,241.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.20
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
| Rate for Payer: Networks By Design Commercial |
$2,353.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,077.85
|
|
|
HC MYELOGRAPHY LUMBAR INJECT L-SPINE
|
Facility
|
IP
|
$3,621.00
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
909062304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$724.20 |
| Max. Negotiated Rate |
$3,258.90 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,896.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,448.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,448.40
|
| Rate for Payer: Galaxy Health WC |
$3,077.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,172.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,258.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,415.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,379.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,241.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.20
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
| Rate for Payer: Networks By Design Commercial |
$2,353.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,077.85
|
|
|
HC MYELOGRAPHY LUMBAR INJECT L-SPINE
|
Facility
|
OP
|
$3,621.00
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
909062304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$724.20 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,003.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$1,599.45
|
| 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 |
$1,991.55
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,896.80
|
| Rate for Payer: Cigna of CA HMO |
$2,317.44
|
| Rate for Payer: Cigna of CA PPO |
$2,679.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$3,077.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,172.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,258.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,505.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,415.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
| Rate for Payer: Multiplan WC |
$1,599.45
|
| Rate for Payer: Networks By Design Commercial |
$2,353.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Preferred Health Network WC |
$1,632.09
|
| Rate for Payer: Prime Health Services Commercial |
$3,077.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.08
|
| Rate for Payer: Prime Health Services WC |
$1,583.13
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,172.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY LUMBAR INJECT T-SPINE
|
Facility
|
IP
|
$3,621.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
909062303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$724.20 |
| Max. Negotiated Rate |
$3,258.90 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,896.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,448.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,448.40
|
| Rate for Payer: Galaxy Health WC |
$3,077.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,172.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,258.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,415.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,379.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,241.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.20
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
| Rate for Payer: Networks By Design Commercial |
$2,353.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,077.85
|
|
|
HC MYELOGRAPHY LUMBAR INJECT T-SPINE
|
Facility
|
OP
|
$3,621.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
909062303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.91 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,003.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$1,599.45
|
| 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 |
$1,991.55
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,896.80
|
| Rate for Payer: Cigna of CA HMO |
$2,317.44
|
| Rate for Payer: Cigna of CA PPO |
$2,679.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$3,077.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,172.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,258.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$188.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,505.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,415.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
| Rate for Payer: Multiplan WC |
$1,599.45
|
| Rate for Payer: Networks By Design Commercial |
$2,353.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Preferred Health Network WC |
$1,632.09
|
| Rate for Payer: Prime Health Services Commercial |
$3,077.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.08
|
| Rate for Payer: Prime Health Services WC |
$1,583.13
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,172.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY, LUMBOSACRAL
|
Facility
|
OP
|
$2,872.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
909001372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$141.01 |
| Max. Negotiated Rate |
$2,584.80 |
| Rate for Payer: Adventist Health Commercial |
$574.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,003.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,744.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$844.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,743.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,140.18
|
| Rate for Payer: Cash Price |
$1,579.60
|
| Rate for Payer: Cash Price |
$1,579.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,297.60
|
| Rate for Payer: Cigna of CA HMO |
$1,838.08
|
| Rate for Payer: Cigna of CA PPO |
$2,125.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$2,441.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,723.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,584.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,505.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,915.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$2,154.00
|
| Rate for Payer: Networks By Design Commercial |
$1,866.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,441.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.08
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,723.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,723.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,265.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,265.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,265.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY, LUMBOSACRAL
|
Facility
|
IP
|
$2,872.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
909001372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.40 |
| Max. Negotiated Rate |
$2,584.80 |
| Rate for Payer: Adventist Health Commercial |
$574.40
|
| Rate for Payer: Cash Price |
$1,579.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,297.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,148.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,148.80
|
| Rate for Payer: Galaxy Health WC |
$2,441.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,723.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,584.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,915.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,094.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.40
|
| Rate for Payer: Multiplan Commercial |
$2,154.00
|
| Rate for Payer: Networks By Design Commercial |
$1,866.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,441.20
|
|
|
HC MYELOGRAPHY, THORACIC
|
Facility
|
IP
|
$2,873.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
909001371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.60 |
| Max. Negotiated Rate |
$2,585.70 |
| Rate for Payer: Adventist Health Commercial |
$574.60
|
| Rate for Payer: Cash Price |
$1,580.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,298.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,149.20
|
| Rate for Payer: Galaxy Health WC |
$2,442.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,723.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,585.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,916.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,094.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,778.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.60
|
| Rate for Payer: Multiplan Commercial |
$2,154.75
|
| Rate for Payer: Networks By Design Commercial |
$1,867.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,442.05
|
|
|
HC MYELOGRAPHY, THORACIC
|
Facility
|
OP
|
$2,873.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
909001371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$149.67 |
| Max. Negotiated Rate |
$2,585.70 |
| Rate for Payer: Adventist Health Commercial |
$574.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,003.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,744.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$897.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,743.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,140.58
|
| Rate for Payer: Cash Price |
$1,580.15
|
| Rate for Payer: Cash Price |
$1,580.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,298.40
|
| Rate for Payer: Cigna of CA HMO |
$1,838.72
|
| Rate for Payer: Cigna of CA PPO |
$2,126.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$2,442.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,723.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,585.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$149.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,505.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,916.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$2,154.75
|
| Rate for Payer: Networks By Design Commercial |
$1,867.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,442.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.08
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,723.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,723.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,265.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,265.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,265.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
