|
HC LSO SAGIT RIGID PANEL PREFAB
|
Facility
|
OP
|
$2,310.00
|
|
|
Service Code
|
CPT L0635
|
| Hospital Charge Code |
905350635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.50 |
| Max. Negotiated Rate |
$2,079.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,963.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,270.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,270.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,118.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,364.75
|
| Rate for Payer: Blue Distinction Transplant |
$1,386.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,732.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,256.64
|
| Rate for Payer: Cash Price |
$1,039.50
|
| Rate for Payer: Cash Price |
$1,039.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,848.00
|
| Rate for Payer: Cigna of CA HMO |
$1,617.00
|
| Rate for Payer: Cigna of CA PPO |
$1,617.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,963.50
|
| Rate for Payer: Dignity Health Media |
$1,963.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,963.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$924.00
|
| Rate for Payer: Galaxy Health WC |
$1,963.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,079.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,732.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$808.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,540.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,460.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.10
|
| Rate for Payer: Multiplan Commercial |
$1,732.50
|
| Rate for Payer: Networks By Design Commercial |
$1,155.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,963.50
|
| Rate for Payer: Riverside University Health System MISP |
$924.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,386.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,386.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,155.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,155.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,155.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,155.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,963.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,963.50
|
|
|
HC LSO SAGITTAL RIGID PANEL CUS
|
Facility
|
IP
|
$3,047.00
|
|
|
Service Code
|
CPT L0636
|
| Hospital Charge Code |
905350636
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$609.40 |
| Max. Negotiated Rate |
$2,742.30 |
| Rate for Payer: Blue Shield of California EPN |
$1,627.10
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,437.60
|
| Rate for Payer: Cigna of CA HMO |
$2,132.90
|
| Rate for Payer: Cigna of CA PPO |
$2,132.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,218.80
|
| Rate for Payer: Galaxy Health WC |
$2,589.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,828.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,742.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,032.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,160.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.40
|
| Rate for Payer: Multiplan Commercial |
$2,285.25
|
| Rate for Payer: Networks By Design Commercial |
$1,523.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,123.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,099.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,005.51
|
|
|
HC LSO SAGITTAL RIGID PANEL CUS
|
Facility
|
OP
|
$3,047.00
|
|
|
Service Code
|
CPT L0636
|
| Hospital Charge Code |
905350636
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,066.45 |
| Max. Negotiated Rate |
$2,742.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,675.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,675.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,475.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,800.17
|
| Rate for Payer: Blue Distinction Transplant |
$1,828.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,285.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,657.57
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,437.60
|
| Rate for Payer: Cigna of CA HMO |
$2,132.90
|
| Rate for Payer: Cigna of CA PPO |
$2,132.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Dignity Health Media |
$2,589.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,589.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,218.80
|
| Rate for Payer: Galaxy Health WC |
$2,589.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,828.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,742.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,285.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,066.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,032.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,161.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,249.27
|
| Rate for Payer: Multiplan Commercial |
$2,285.25
|
| Rate for Payer: Networks By Design Commercial |
$1,523.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,218.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,828.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,828.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,523.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,523.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,523.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,523.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,589.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,589.95
|
|
|
HC LSO SAG RIGID ANT/POST PANEL S1-T9 CUSTOM
|
Facility
|
OP
|
$3,047.00
|
|
|
Service Code
|
CPT L0632
|
| Hospital Charge Code |
905350632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,066.45 |
| Max. Negotiated Rate |
$2,742.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,675.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,675.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,475.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,800.17
|
| Rate for Payer: Blue Distinction Transplant |
$1,828.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,285.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,657.57
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,437.60
|
| Rate for Payer: Cigna of CA HMO |
$2,132.90
|
| Rate for Payer: Cigna of CA PPO |
$2,132.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,589.95
|
| Rate for Payer: Dignity Health Media |
$2,589.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,589.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,218.80
|
| Rate for Payer: Galaxy Health WC |
$2,589.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,828.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,742.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,285.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,066.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,032.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,249.27
|
| Rate for Payer: Multiplan Commercial |
$2,285.25
|
| Rate for Payer: Networks By Design Commercial |
$1,523.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,218.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,828.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,828.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,523.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,523.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,523.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,523.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,589.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,589.95
|
|
|
HC LSO SAG RIGID ANT/POST PANEL S1-T9 CUSTOM
|
Facility
|
IP
|
$3,047.00
|
|
|
Service Code
|
CPT L0632
|
| Hospital Charge Code |
905350632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$609.40 |
| Max. Negotiated Rate |
$2,742.30 |
| Rate for Payer: Blue Shield of California EPN |
$1,627.10
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,437.60
|
| Rate for Payer: Cigna of CA HMO |
$2,132.90
|
| Rate for Payer: Cigna of CA PPO |
$2,132.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,218.80
|
| Rate for Payer: Galaxy Health WC |
$2,589.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,828.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,742.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,032.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,160.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.40
|
| Rate for Payer: Multiplan Commercial |
$2,285.25
|
| Rate for Payer: Networks By Design Commercial |
$1,523.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,123.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,099.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,005.51
|
|
|
HC LSO S/C SHELL/PANEL CUSTOM
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
CPT L0640
|
| Hospital Charge Code |
905350640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$1,479.60 |
| Rate for Payer: Blue Shield of California EPN |
$877.90
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Cigna of CA HMO |
$1,150.80
|
| Rate for Payer: Cigna of CA PPO |
$1,150.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$822.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$620.77
|
| Rate for Payer: United Healthcare All Other HMO |
$606.31
|
| Rate for Payer: United Healthcare HMO Rider |
$593.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.52
|
|
|
HC LSO S/C SHELL/PANEL CUSTOM
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT L0640
|
| Hospital Charge Code |
905350640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$575.40 |
| Max. Negotiated Rate |
$1,479.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$904.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$904.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$796.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$971.28
|
| Rate for Payer: Blue Distinction Transplant |
$986.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,233.00
|
| Rate for Payer: Blue Shield of California EPN |
$894.34
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Cigna of CA HMO |
$1,150.80
|
| Rate for Payer: Cigna of CA PPO |
$1,150.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Dignity Health Media |
$1,397.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,397.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,233.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$575.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,249.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.04
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$822.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: Riverside University Health System MISP |
$657.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$986.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$822.00
|
| Rate for Payer: United Healthcare HMO Rider |
$822.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$822.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,397.40
|
|
|
HC LSO S/C SHELL/PANEL PREFAB
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
CPT L0639
|
| Hospital Charge Code |
905350639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$382.00 |
| Max. Negotiated Rate |
$1,719.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,019.94
|
| Rate for Payer: Cash Price |
$859.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,528.00
|
| Rate for Payer: Cigna of CA HMO |
$1,337.00
|
| Rate for Payer: Cigna of CA PPO |
$1,337.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$764.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$764.00
|
| Rate for Payer: Galaxy Health WC |
$1,623.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,146.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,719.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,273.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$727.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.00
|
| Rate for Payer: Multiplan Commercial |
$1,432.50
|
| Rate for Payer: Networks By Design Commercial |
$955.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,623.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.22
|
| Rate for Payer: United Healthcare All Other HMO |
$704.41
|
| Rate for Payer: United Healthcare HMO Rider |
$689.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$630.30
|
|
|
HC LSO S/C SHELL/PANEL PREFAB
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
CPT L0639
|
| Hospital Charge Code |
905350639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$668.50 |
| Max. Negotiated Rate |
$1,719.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,623.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,050.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,050.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$924.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,128.43
|
| Rate for Payer: Blue Distinction Transplant |
$1,146.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,432.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,039.04
|
| Rate for Payer: Cash Price |
$859.50
|
| Rate for Payer: Cash Price |
$859.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,528.00
|
| Rate for Payer: Cigna of CA HMO |
$1,337.00
|
| Rate for Payer: Cigna of CA PPO |
$1,337.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,623.50
|
| Rate for Payer: Dignity Health Media |
$1,623.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,623.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$764.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$764.00
|
| Rate for Payer: Galaxy Health WC |
$1,623.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,146.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,719.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,432.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$668.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,273.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,444.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.10
|
| Rate for Payer: Multiplan Commercial |
$1,432.50
|
| Rate for Payer: Networks By Design Commercial |
$955.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,623.50
|
| Rate for Payer: Riverside University Health System MISP |
$764.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,146.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,146.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$955.00
|
| Rate for Payer: United Healthcare All Other HMO |
$955.00
|
| Rate for Payer: United Healthcare HMO Rider |
$955.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,623.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,623.50
|
|
|
HC LUMBAR DISCOGRAPHY, 1 LEVEL
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
909000183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$443.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$483.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Central Health Plan Commercial |
$644.80
|
| Rate for Payer: Cigna of CA PPO |
$596.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.10
|
| Rate for Payer: Dignity Health Media |
$685.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$725.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$604.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$282.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.20
|
| Rate for Payer: Multiplan Commercial |
$604.50
|
| Rate for Payer: Networks By Design Commercial |
$523.90
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: Riverside University Health System MISP |
$322.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.10
|
| Rate for Payer: Vantage Medical Group Senior |
$685.10
|
|
|
HC LUMBAR DISCOGRAPHY, 1 LEVEL
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
909000183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$725.40 |
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Central Health Plan Commercial |
$644.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$725.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.20
|
| Rate for Payer: Multiplan Commercial |
$604.50
|
| Rate for Payer: Networks By Design Commercial |
$523.90
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
|
|
HC LUMBAR PUNCTURE FOR MYELOGR
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
909000181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$635.40 |
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Central Health Plan Commercial |
$564.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$635.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.20
|
| Rate for Payer: Multiplan Commercial |
$529.50
|
| Rate for Payer: Networks By Design Commercial |
$458.90
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
|
|
HC LUMBAR PUNCTURE FOR MYELOGR
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
909000181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$600.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$388.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$388.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$423.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Central Health Plan Commercial |
$564.80
|
| Rate for Payer: Cigna of CA PPO |
$522.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$600.10
|
| Rate for Payer: Dignity Health Media |
$600.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$600.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$635.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$529.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$247.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.20
|
| Rate for Payer: Multiplan Commercial |
$529.50
|
| Rate for Payer: Networks By Design Commercial |
$458.90
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
| Rate for Payer: Riverside University Health System MISP |
$282.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$600.10
|
| Rate for Payer: Vantage Medical Group Senior |
$600.10
|
|
|
HC LUMBAR/SACRAL FACET INJ 3RD EA
|
Facility
|
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
909020044
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$293.20 |
| Max. Negotiated Rate |
$1,319.40 |
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,172.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.40
|
| Rate for Payer: Galaxy Health WC |
$1,246.10
|
| Rate for Payer: Global Benefits Group Commercial |
$879.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,319.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.20
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
| Rate for Payer: Networks By Design Commercial |
$952.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,246.10
|
|
|
HC LUMBAR/SACRAL FACET INJ 3RD EA
|
Facility
|
OP
|
$1,466.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
909020044
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.77 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,246.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$806.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$879.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,172.80
|
| Rate for Payer: Cigna of CA PPO |
$1,084.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,246.10
|
| Rate for Payer: Dignity Health Media |
$1,246.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,246.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$586.40
|
| Rate for Payer: Galaxy Health WC |
$1,246.10
|
| Rate for Payer: Global Benefits Group Commercial |
$879.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,319.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,099.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$513.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.20
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
| Rate for Payer: Networks By Design Commercial |
$952.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,246.10
|
| Rate for Payer: Riverside University Health System MISP |
$586.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$879.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,246.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,246.10
|
|
|
HC LUMBAR/SACRAL FACET INJECT/ADD
|
Facility
|
IP
|
$2,675.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
909000186
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$535.00 |
| Max. Negotiated Rate |
$2,407.50 |
| Rate for Payer: Cash Price |
$1,203.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,070.00
|
| Rate for Payer: Galaxy Health WC |
$2,273.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,605.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,407.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,784.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,019.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.00
|
| Rate for Payer: Multiplan Commercial |
$2,006.25
|
| Rate for Payer: Networks By Design Commercial |
$1,738.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,273.75
|
|
|
HC LUMBAR/SACRAL FACET INJECT/ADD
|
Facility
|
OP
|
$2,675.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
909000186
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,273.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,471.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,471.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,605.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$1,203.75
|
| Rate for Payer: Cash Price |
$1,203.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,140.00
|
| Rate for Payer: Cigna of CA PPO |
$1,979.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,273.75
|
| Rate for Payer: Dignity Health Media |
$2,273.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,273.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,070.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,070.00
|
| Rate for Payer: Galaxy Health WC |
$2,273.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,605.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,407.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,006.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,784.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.00
|
| Rate for Payer: Multiplan Commercial |
$2,006.25
|
| Rate for Payer: Networks By Design Commercial |
$1,738.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,273.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,070.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,605.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,273.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,273.75
|
|
|
HC LUMBAR/SACRAL FACET INJECT/INT
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
909000185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$274.46 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,569.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Cash Price |
$1,177.20
|
| Rate for Payer: Cash Price |
$1,177.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,092.80
|
| Rate for Payer: Cigna of CA PPO |
$1,935.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,223.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,354.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,962.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$1,962.00
|
| Rate for Payer: Networks By Design Commercial |
$1,700.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,223.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,569.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC LUMBAR/SACRAL FACET INJECT/INT
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
909000185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$523.20 |
| Max. Negotiated Rate |
$2,354.40 |
| Rate for Payer: Cash Price |
$1,177.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,092.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,046.40
|
| Rate for Payer: Galaxy Health WC |
$2,223.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,354.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$996.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.20
|
| Rate for Payer: Multiplan Commercial |
$1,962.00
|
| Rate for Payer: Networks By Design Commercial |
$1,700.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,223.60
|
|
|
HC LUMBAR SPINE AP AND LATERAL
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
|
|
HC LUMBAR SPINE AP AND LATERAL
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.55 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.14
|
| Rate for Payer: Blue Distinction Transplant |
$655.80
|
| Rate for Payer: Blue Shield of California Commercial |
$675.47
|
| Rate for Payer: Blue Shield of California EPN |
$531.20
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: Cigna of CA HMO |
$699.52
|
| Rate for Payer: Cigna of CA PPO |
$808.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$819.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC LUMBAR SPINE LIMITED
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$226.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.14
|
| Rate for Payer: Blue Distinction Transplant |
$130.20
|
| Rate for Payer: Blue Shield of California Commercial |
$134.11
|
| Rate for Payer: Blue Shield of California EPN |
$105.46
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$162.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC LUMBAR SPINE LIMITED
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
|
|
HC LUM/SAC ABL EA ADD LEVEL
|
Facility
|
IP
|
$3,304.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909000263
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.80 |
| Max. Negotiated Rate |
$2,973.60 |
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,321.60
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,203.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,258.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
|
|
HC LUM/SAC ABL EA ADD LEVEL
|
Facility
|
OP
|
$3,304.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909000263
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.49 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,808.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,817.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,817.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,982.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Cigna of CA PPO |
$2,444.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,808.40
|
| Rate for Payer: Dignity Health Media |
$2,808.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,808.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,321.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,321.60
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,478.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,156.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,203.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,321.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,982.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,808.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,808.40
|
|
