|
HC LUM SPINE BEND ONLY/4 VIEWS
|
Facility
IP
|
$1,296.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
909001318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$259.20 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,036.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$518.40
|
| Rate for Payer: Galaxy Health WC |
$1,101.60
|
| Rate for Payer: Global Benefits Group Commercial |
$777.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,166.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$864.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Multiplan Commercial |
$972.00
|
| Rate for Payer: Networks By Design Commercial |
$842.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,101.60
|
|
|
HC LUM SPINE BEND ONLY/4 VIEWS
|
Facility
OP
|
$1,296.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
909001318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.69 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$224.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.59
|
| Rate for Payer: BCBS Transplant Transplant |
$777.60
|
| Rate for Payer: Blue Shield of California Commercial |
$800.93
|
| Rate for Payer: Blue Shield of California EPN |
$629.86
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,036.80
|
| Rate for Payer: Cigna of CA HMO |
$829.44
|
| Rate for Payer: Cigna of CA PPO |
$959.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| 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 |
$1,101.60
|
| Rate for Payer: Global Benefits Group Commercial |
$777.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,166.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$972.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$864.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$972.00
|
| Rate for Payer: Networks By Design Commercial |
$842.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,101.60
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$777.60
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$777.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$777.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: 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 LUM SPINE COMP W/BENDING VIEWS
|
Facility
IP
|
$2,003.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
909001316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$400.60 |
| Max. Negotiated Rate |
$1,802.70 |
| Rate for Payer: Cash Price |
$901.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,602.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$801.20
|
| Rate for Payer: Galaxy Health WC |
$1,702.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,201.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,802.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,336.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.60
|
| Rate for Payer: Multiplan Commercial |
$1,502.25
|
| Rate for Payer: Networks By Design Commercial |
$1,301.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,702.55
|
|
|
HC LUM SPINE COMP W/BENDING VIEWS
|
Facility
OP
|
$2,003.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
909001316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,802.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$246.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.43
|
| Rate for Payer: BCBS Transplant Transplant |
$1,201.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,237.85
|
| Rate for Payer: Blue Shield of California EPN |
$973.46
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$901.35
|
| Rate for Payer: Cash Price |
$901.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,602.40
|
| Rate for Payer: Cigna of CA HMO |
$1,281.92
|
| Rate for Payer: Cigna of CA PPO |
$1,482.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| 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 |
$1,702.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,201.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,802.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,502.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.60
|
| 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 |
$1,502.25
|
| Rate for Payer: Networks By Design Commercial |
$1,301.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,702.55
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,201.80
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,201.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,201.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: 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 LUM SPINE W/OBLIQUES
|
Facility
IP
|
$1,441.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
909001317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$288.20 |
| Max. Negotiated Rate |
$1,296.90 |
| Rate for Payer: Cash Price |
$648.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,152.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.40
|
| Rate for Payer: Galaxy Health WC |
$1,224.85
|
| Rate for Payer: Global Benefits Group Commercial |
$864.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,296.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$961.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.20
|
| Rate for Payer: Multiplan Commercial |
$1,080.75
|
| Rate for Payer: Networks By Design Commercial |
$936.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.85
|
|
|
HC LUM SPINE W/OBLIQUES
|
Facility
OP
|
$1,441.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
909001317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,296.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$224.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$190.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.39
|
| Rate for Payer: BCBS Transplant Transplant |
$864.60
|
| Rate for Payer: Blue Shield of California Commercial |
$890.54
|
| Rate for Payer: Blue Shield of California EPN |
$700.33
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$648.45
|
| Rate for Payer: Cash Price |
$648.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,152.80
|
| Rate for Payer: Cigna of CA HMO |
$922.24
|
| Rate for Payer: Cigna of CA PPO |
$1,066.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| 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 |
$1,224.85
|
| Rate for Payer: Global Benefits Group Commercial |
$864.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,296.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,080.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$961.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,080.75
|
| Rate for Payer: Networks By Design Commercial |
$936.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.85
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$864.60
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$864.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$864.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: 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 LUNG DIFFER PERF & VENTILATION
|
Facility
OP
|
$5,027.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
909301402
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$675.33 |
| Max. Negotiated Rate |
$4,524.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$675.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,486.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,583.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,931.57
|
| Rate for Payer: BCBS Transplant Transplant |
$3,016.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,106.69
|
| Rate for Payer: Blue Shield of California EPN |
$2,443.12
|
| Rate for Payer: Caremore Medicare Advantage |
$675.33
|
| Rate for Payer: Cash Price |
$2,262.15
|
| Rate for Payer: Cash Price |
$2,262.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,021.60
|
| Rate for Payer: Cigna of CA HMO |
$3,217.28
|
| Rate for Payer: Cigna of CA PPO |
$3,719.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$4,272.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,016.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,524.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,770.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,107.54
|
| Rate for Payer: IEHP medi-cal |
$1,114.29
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Innovage PACE Commercial |
$1,013.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,353.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$3,770.25
|
| Rate for Payer: Networks By Design Commercial |
$3,267.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,272.95
|
| Rate for Payer: Prime Health Services Medicare |
$715.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,016.20
|
| Rate for Payer: Riverside University Health MISP |
$742.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,016.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,016.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$809.82
|
| Rate for Payer: United Healthcare All Other HMO |
$809.82
|
| Rate for Payer: United Healthcare HMO Rider |
$809.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$809.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC LUNG DIFFER PERF & VENTILATION
|
Facility
IP
|
$5,027.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
909301402
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,005.40 |
| Max. Negotiated Rate |
$4,524.30 |
| Rate for Payer: Cash Price |
$2,262.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,021.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,010.80
|
| Rate for Payer: Galaxy Health WC |
$4,272.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,016.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,524.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,353.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.40
|
| Rate for Payer: Multiplan Commercial |
$3,770.25
|
| Rate for Payer: Networks By Design Commercial |
$3,267.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,272.95
|
|
|
HC LUPUS SCREEN PTT
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900912006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$53.29 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.29
|
| Rate for Payer: BCBS Transplant Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.01
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.86
|
| Rate for Payer: IEHP medi-cal |
$9.92
|
| Rate for Payer: IEHP Medicare Advantage |
$6.01
|
| Rate for Payer: Innovage PACE Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$6.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: Riverside University Health MISP |
$6.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC LUPUS SCREEN PTT
|
Facility
IP
|
$194.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900912006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
|
|
HC LUTEINIZING HORMON
|
Facility
IP
|
$273.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
900910886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
|
|
HC LUTEINIZING HORMON
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
900910886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$164.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$134.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.34
|
| Rate for Payer: BCBS Transplant Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.25
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Caremore Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.52
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.37
|
| Rate for Payer: IEHP medi-cal |
$30.56
|
| Rate for Payer: IEHP Medicare Advantage |
$18.52
|
| Rate for Payer: Innovage PACE Commercial |
$27.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.82
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$19.63
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: Riverside University Health MISP |
$20.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
|
|
HC LYMPHANGIOGRAM, ABD/PLV UL
|
Facility
OP
|
$1,762.00
|
|
|
Service Code
|
CPT 75805
|
| Hospital Charge Code |
909001374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$6,571.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,287.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,269.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,548.76
|
| Rate for Payer: BCBS Transplant Transplant |
$1,057.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,088.92
|
| Rate for Payer: Blue Shield of California EPN |
$856.33
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,409.60
|
| Rate for Payer: Cigna of CA HMO |
$1,127.68
|
| Rate for Payer: Cigna of CA PPO |
$1,303.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$1,497.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,057.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,585.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,321.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,175.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
| Rate for Payer: Networks By Design Commercial |
$1,145.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,497.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,057.20
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,057.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,057.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC LYMPHANGIOGRAM, ABD/PLV UL
|
Facility
IP
|
$1,762.00
|
|
|
Service Code
|
CPT 75805
|
| Hospital Charge Code |
909001374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$1,585.80 |
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,409.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.80
|
| Rate for Payer: Galaxy Health WC |
$1,497.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,057.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,585.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,175.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.40
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
| Rate for Payer: Networks By Design Commercial |
$1,145.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,497.70
|
|
|
HC LYMPHANGIOGRAM EXT BILAT
|
Facility
OP
|
$2,638.00
|
|
|
Service Code
|
CPT 75803
|
| Hospital Charge Code |
909001373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$527.60 |
| Max. Negotiated Rate |
$3,301.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,001.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,287.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,127.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,375.75
|
| Rate for Payer: BCBS Transplant Transplant |
$1,582.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,630.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,282.07
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,110.40
|
| Rate for Payer: Cigna of CA HMO |
$1,688.32
|
| Rate for Payer: Cigna of CA PPO |
$1,952.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$2,242.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,374.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,978.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: IEHP medi-cal |
$3,301.67
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Innovage PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,759.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$1,978.50
|
| Rate for Payer: Networks By Design Commercial |
$1,714.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,242.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,582.80
|
| Rate for Payer: Riverside University Health MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,582.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,582.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC LYMPHANGIOGRAM EXT BILAT
|
Facility
IP
|
$2,638.00
|
|
|
Service Code
|
CPT 75803
|
| Hospital Charge Code |
909001373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$527.60 |
| Max. Negotiated Rate |
$2,374.20 |
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,110.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,055.20
|
| Rate for Payer: Galaxy Health WC |
$2,242.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,374.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,759.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.60
|
| Rate for Payer: Multiplan Commercial |
$1,978.50
|
| Rate for Payer: Networks By Design Commercial |
$1,714.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,242.30
|
|
|
HC LYMPHANGIOGRAM EXT UNILAT
|
Facility
OP
|
$1,758.00
|
|
|
Service Code
|
CPT 75801
|
| Hospital Charge Code |
909001375
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$2,287.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,287.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,127.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,375.75
|
| Rate for Payer: BCBS Transplant Transplant |
$1,054.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.44
|
| Rate for Payer: Blue Shield of California EPN |
$854.39
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,406.40
|
| Rate for Payer: Cigna of CA HMO |
$1,125.12
|
| Rate for Payer: Cigna of CA PPO |
$1,300.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,582.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,318.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: IEHP medi-cal |
$1,295.08
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Innovage PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,172.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$1,318.50
|
| Rate for Payer: Networks By Design Commercial |
$1,142.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,494.30
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,054.80
|
| Rate for Payer: Riverside University Health MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,054.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,054.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC LYMPHANGIOGRAM EXT UNILAT
|
Facility
IP
|
$1,758.00
|
|
|
Service Code
|
CPT 75801
|
| Hospital Charge Code |
909001375
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$1,582.20 |
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.20
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,582.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,172.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.60
|
| Rate for Payer: Multiplan Commercial |
$1,318.50
|
| Rate for Payer: Networks By Design Commercial |
$1,142.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,494.30
|
|
|
HC LYMPHANGIOGRAM, PELV BILAT
|
Facility
IP
|
$2,643.00
|
|
|
Service Code
|
CPT 75807
|
| Hospital Charge Code |
909001365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$528.60 |
| Max. Negotiated Rate |
$2,378.70 |
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,057.20
|
| Rate for Payer: Galaxy Health WC |
$2,246.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.60
|
| Rate for Payer: Multiplan Commercial |
$1,982.25
|
| Rate for Payer: Networks By Design Commercial |
$1,717.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,246.55
|
|
|
HC LYMPHANGIOGRAM, PELV BILAT
|
Facility
OP
|
$2,643.00
|
|
|
Service Code
|
CPT 75807
|
| Hospital Charge Code |
909001365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$528.60 |
| Max. Negotiated Rate |
$6,571.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,287.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,263.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,540.58
|
| Rate for Payer: BCBS Transplant Transplant |
$1,585.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,633.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,284.50
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,114.40
|
| Rate for Payer: Cigna of CA HMO |
$1,691.52
|
| Rate for Payer: Cigna of CA PPO |
$1,955.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$2,246.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,378.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,982.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$1,982.25
|
| Rate for Payer: Networks By Design Commercial |
$1,717.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,246.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,585.80
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,585.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,585.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC LYMPHANGIOGRAPHY INJECTION
|
Facility
OP
|
$659.00
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
909000131
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$560.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$362.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$362.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$395.40
|
| 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 |
$296.55
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Central Health Plan Commercial |
$527.20
|
| Rate for Payer: Cigna of CA PPO |
$487.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$560.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$593.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$494.25
|
| Rate for Payer: IEHP medi-cal |
$230.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.80
|
| Rate for Payer: Multiplan Commercial |
$494.25
|
| Rate for Payer: Networks By Design Commercial |
$428.35
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$395.40
|
| Rate for Payer: Riverside University Health MISP |
$263.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$395.40
|
| 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 |
$560.15
|
| Rate for Payer: Vantage Medical Group Senior |
$560.15
|
|
|
HC LYMPHANGIOGRAPHY INJECTION
|
Facility
IP
|
$659.00
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
909000131
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$593.10 |
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Central Health Plan Commercial |
$527.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$593.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.80
|
| Rate for Payer: Multiplan Commercial |
$494.25
|
| Rate for Payer: Networks By Design Commercial |
$428.35
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
|
|
HC LYMPHAT/ANTIMONY SCA
|
Facility
IP
|
$3,347.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
909301341
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$669.40 |
| Max. Negotiated Rate |
$3,012.30 |
| Rate for Payer: Cash Price |
$1,506.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,677.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,338.80
|
| Rate for Payer: Galaxy Health WC |
$2,844.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,008.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,012.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,232.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.40
|
| Rate for Payer: Multiplan Commercial |
$2,510.25
|
| Rate for Payer: Networks By Design Commercial |
$2,175.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,844.95
|
|
|
HC LYMPHAT/ANTIMONY SCA
|
Facility
OP
|
$3,347.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
909301341
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$654.98 |
| Max. Negotiated Rate |
$3,012.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$675.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,443.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$848.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,977.41
|
| Rate for Payer: BCBS Transplant Transplant |
$2,008.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,068.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,626.64
|
| Rate for Payer: Caremore Medicare Advantage |
$675.33
|
| Rate for Payer: Cash Price |
$1,506.15
|
| Rate for Payer: Cash Price |
$1,506.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,677.60
|
| Rate for Payer: Cigna of CA HMO |
$2,142.08
|
| Rate for Payer: Cigna of CA PPO |
$2,476.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$2,844.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,008.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,012.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,510.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,107.54
|
| Rate for Payer: IEHP medi-cal |
$1,114.29
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Innovage PACE Commercial |
$1,013.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,232.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$2,510.25
|
| Rate for Payer: Networks By Design Commercial |
$2,175.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,844.95
|
| Rate for Payer: Prime Health Services Medicare |
$715.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,008.20
|
| Rate for Payer: Riverside University Health MISP |
$742.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,008.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,008.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$654.98
|
| Rate for Payer: United Healthcare All Other HMO |
$654.98
|
| Rate for Payer: United Healthcare HMO Rider |
$654.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC LYMPH NODE NDLE BPSY, DP AX
|
Facility
IP
|
$8,462.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
909000129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,692.40 |
| Max. Negotiated Rate |
$7,615.80 |
| Rate for Payer: Cash Price |
$3,807.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,769.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,384.80
|
| Rate for Payer: Galaxy Health WC |
$7,192.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,077.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,615.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,644.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,692.40
|
| Rate for Payer: Multiplan Commercial |
$6,346.50
|
| Rate for Payer: Networks By Design Commercial |
$5,500.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,192.70
|
|
