|
HC MUSCLE TEST COMPUTER 30MIN OT
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 97752
|
| Hospital Charge Code |
903207752
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$383.40 |
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Central Health Plan Commercial |
$340.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.40
|
| Rate for Payer: Galaxy Health WC |
$362.10
|
| Rate for Payer: Global Benefits Group Commercial |
$255.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$383.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.20
|
| Rate for Payer: Multiplan Commercial |
$319.50
|
| Rate for Payer: Networks By Design Commercial |
$276.90
|
| Rate for Payer: Prime Health Services Commercial |
$362.10
|
|
|
HC MUSCLE TEST COMPUTER 30MIN OT
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 97752
|
| Hospital Charge Code |
903207752
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$258.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$255.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Central Health Plan Commercial |
$340.80
|
| Rate for Payer: Cigna of CA HMO |
$272.64
|
| Rate for Payer: Cigna of CA PPO |
$315.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.10
|
| Rate for Payer: Dignity Health Media |
$362.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$170.40
|
| Rate for Payer: Galaxy Health WC |
$362.10
|
| Rate for Payer: Global Benefits Group Commercial |
$255.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$383.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$319.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$149.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.66
|
| Rate for Payer: Multiplan Commercial |
$319.50
|
| Rate for Payer: Networks By Design Commercial |
$276.90
|
| Rate for Payer: Prime Health Services Commercial |
$362.10
|
| Rate for Payer: Riverside University Health System MISP |
$170.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$255.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$255.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.10
|
| Rate for Payer: Vantage Medical Group Senior |
$362.10
|
|
|
HC MYELOGRAM, CERVICAL
|
Facility
|
OP
|
$2,938.00
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
909001363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.34 |
| Max. Negotiated Rate |
$2,644.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$560.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$982.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,198.98
|
| Rate for Payer: Blue Distinction Transplant |
$1,762.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,815.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.87
|
| Rate for Payer: Caremore Medicare Advantage |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,350.40
|
| Rate for Payer: Cigna of CA HMO |
$1,880.32
|
| Rate for Payer: Cigna of CA PPO |
$2,174.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,644.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,203.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,203.50
|
| Rate for Payer: Networks By Design Commercial |
$1,909.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,265.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,265.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,265.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAM, CERVICAL
|
Facility
|
IP
|
$2,938.00
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
909001363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$587.60 |
| Max. Negotiated Rate |
$2,644.20 |
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,350.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,644.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.60
|
| Rate for Payer: Multiplan Commercial |
$2,203.50
|
| Rate for Payer: Networks By Design Commercial |
$1,909.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
|
|
HC MYELOGRAM, COMPLETE
|
Facility
|
IP
|
$3,235.00
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
909001364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$647.00 |
| Max. Negotiated Rate |
$2,911.50 |
| Rate for Payer: Cash Price |
$1,455.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,588.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,294.00
|
| Rate for Payer: Galaxy Health WC |
$2,749.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,941.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,911.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,157.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,232.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.00
|
| Rate for Payer: Multiplan Commercial |
$2,426.25
|
| Rate for Payer: Networks By Design Commercial |
$2,102.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,749.75
|
|
|
HC MYELOGRAM, COMPLETE
|
Facility
|
OP
|
$3,235.00
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
909001364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.55 |
| Max. Negotiated Rate |
$2,911.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$839.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,263.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,540.63
|
| Rate for Payer: Blue Distinction Transplant |
$1,941.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,999.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,572.21
|
| Rate for Payer: Caremore Medicare Advantage |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,455.75
|
| Rate for Payer: Cash Price |
$1,455.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,588.00
|
| Rate for Payer: Cigna of CA HMO |
$2,070.40
|
| Rate for Payer: Cigna of CA PPO |
$2,393.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,749.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,941.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,911.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,426.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,157.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,426.25
|
| Rate for Payer: Networks By Design Commercial |
$2,102.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,749.75
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,941.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,941.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,265.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,265.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,265.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAPHY LUMBAR INJECT 2 OR GT LVLS
|
Facility
|
OP
|
$2,738.00
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
909062305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$547.60 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| 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 |
$1,642.80
|
| 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 |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,190.40
|
| Rate for Payer: Cigna of CA PPO |
$2,026.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,327.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,642.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,464.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,053.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,826.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,053.50
|
| Rate for Payer: Networks By Design Commercial |
$1,779.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,327.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,642.80
|
| 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 |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAPHY LUMBAR INJECT 2 OR GT LVLS
|
Facility
|
IP
|
$2,738.00
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
909062305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$547.60 |
| Max. Negotiated Rate |
$2,464.20 |
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,095.20
|
| Rate for Payer: Galaxy Health WC |
$2,327.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,642.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,464.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,826.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,043.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.60
|
| Rate for Payer: Multiplan Commercial |
$2,053.50
|
| Rate for Payer: Networks By Design Commercial |
$1,779.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,327.30
|
|
|
HC MYELOGRAPHY LUMBAR INJECT C-SPINE
|
Facility
|
IP
|
$2,738.00
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
909062302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$547.60 |
| Max. Negotiated Rate |
$2,464.20 |
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,095.20
|
| Rate for Payer: Galaxy Health WC |
$2,327.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,642.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,464.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,826.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,043.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.60
|
| Rate for Payer: Multiplan Commercial |
$2,053.50
|
| Rate for Payer: Networks By Design Commercial |
$1,779.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,327.30
|
|
|
HC MYELOGRAPHY LUMBAR INJECT C-SPINE
|
Facility
|
OP
|
$2,738.00
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
909062302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$205.85 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| 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 |
$1,642.80
|
| 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 |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,190.40
|
| Rate for Payer: Cigna of CA PPO |
$2,026.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,327.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,642.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,464.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,053.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,826.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,053.50
|
| Rate for Payer: Networks By Design Commercial |
$1,779.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,327.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,642.80
|
| 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 |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAPHY LUMBAR INJECT L-SPINE
|
Facility
|
OP
|
$2,738.00
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
909062304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$547.60 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| 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 |
$1,642.80
|
| 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 |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,190.40
|
| Rate for Payer: Cigna of CA PPO |
$2,026.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,327.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,642.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,464.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,053.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,826.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,053.50
|
| Rate for Payer: Networks By Design Commercial |
$1,779.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,327.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,642.80
|
| 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 |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAPHY LUMBAR INJECT L-SPINE
|
Facility
|
IP
|
$2,738.00
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
909062304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$547.60 |
| Max. Negotiated Rate |
$2,464.20 |
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,095.20
|
| Rate for Payer: Galaxy Health WC |
$2,327.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,642.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,464.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,826.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,043.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.60
|
| Rate for Payer: Multiplan Commercial |
$2,053.50
|
| Rate for Payer: Networks By Design Commercial |
$1,779.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,327.30
|
|
|
HC MYELOGRAPHY LUMBAR INJECT T-SPINE
|
Facility
|
OP
|
$2,738.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
909062303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.68 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| 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 |
$1,642.80
|
| 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 |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,190.40
|
| Rate for Payer: Cigna of CA PPO |
$2,026.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,327.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,642.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,464.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,053.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,826.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,053.50
|
| Rate for Payer: Networks By Design Commercial |
$1,779.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,327.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,642.80
|
| 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 |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAPHY LUMBAR INJECT T-SPINE
|
Facility
|
IP
|
$2,738.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
909062303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$547.60 |
| Max. Negotiated Rate |
$2,464.20 |
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,095.20
|
| Rate for Payer: Galaxy Health WC |
$2,327.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,642.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,464.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,826.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,043.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.60
|
| Rate for Payer: Multiplan Commercial |
$2,053.50
|
| Rate for Payer: Networks By Design Commercial |
$1,779.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,327.30
|
|
|
HC MYELOGRAPHY, LUMBOSACRAL
|
Facility
|
IP
|
$2,938.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
909001372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$587.60 |
| Max. Negotiated Rate |
$2,644.20 |
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,350.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,644.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.60
|
| Rate for Payer: Multiplan Commercial |
$2,203.50
|
| Rate for Payer: Networks By Design Commercial |
$1,909.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
|
|
HC MYELOGRAPHY, LUMBOSACRAL
|
Facility
|
OP
|
$2,938.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
909001372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.76 |
| Max. Negotiated Rate |
$2,644.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$545.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$844.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.56
|
| Rate for Payer: Blue Distinction Transplant |
$1,762.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,815.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.87
|
| Rate for Payer: Caremore Medicare Advantage |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,350.40
|
| Rate for Payer: Cigna of CA HMO |
$1,880.32
|
| Rate for Payer: Cigna of CA PPO |
$2,174.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,644.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,203.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,203.50
|
| Rate for Payer: Networks By Design Commercial |
$1,909.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,265.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,265.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,265.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAPHY, THORACIC
|
Facility
|
IP
|
$2,939.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
909001371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$587.80 |
| Max. Negotiated Rate |
$2,645.10 |
| Rate for Payer: Cash Price |
$1,322.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,351.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.60
|
| Rate for Payer: Galaxy Health WC |
$2,498.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,763.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,645.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.80
|
| Rate for Payer: Multiplan Commercial |
$2,204.25
|
| Rate for Payer: Networks By Design Commercial |
$1,910.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,498.15
|
|
|
HC MYELOGRAPHY, THORACIC
|
Facility
|
OP
|
$2,939.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
909001371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.34 |
| Max. Negotiated Rate |
$2,645.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$514.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$897.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,094.44
|
| Rate for Payer: Blue Distinction Transplant |
$1,763.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,816.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,428.35
|
| Rate for Payer: Caremore Medicare Advantage |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,322.55
|
| Rate for Payer: Cash Price |
$1,322.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,351.20
|
| Rate for Payer: Cigna of CA HMO |
$1,880.96
|
| Rate for Payer: Cigna of CA PPO |
$2,174.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,498.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,763.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,645.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,204.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,204.25
|
| Rate for Payer: Networks By Design Commercial |
$1,910.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,498.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,763.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,763.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,265.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,265.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,265.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYLOPEROXIDASE AB
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913678
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC MYLOPEROXIDASE AB
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913678
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$207.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.60
|
| Rate for Payer: Blue Distinction Transplant |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$45.11
|
| Rate for Payer: Blue Shield of California EPN |
$35.48
|
| Rate for Payer: Caremore Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Central Health Plan Commercial |
$58.40
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Media |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: InnovAge PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC MYOCARDIAL PERFUSION MULTIPLE TEST
|
Facility
|
OP
|
$2,799.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
909301383
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$319.79 |
| Max. Negotiated Rate |
$2,927.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,774.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,015.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$682.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,653.65
|
| Rate for Payer: Blue Distinction Transplant |
$1,679.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,729.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,360.31
|
| Rate for Payer: Caremore Medicare Advantage |
$1,774.15
|
| Rate for Payer: Cash Price |
$1,259.55
|
| Rate for Payer: Cash Price |
$1,259.55
|
| Rate for Payer: Center for Health Promotion Commercial |
$1,325.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,239.20
|
| Rate for Payer: Cigna of CA HMO |
$1,791.36
|
| Rate for Payer: Cigna of CA PPO |
$2,071.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$2,379.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,679.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,519.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,099.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,909.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,927.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: InnovAge PACE Commercial |
$2,661.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,866.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$559.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,377.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$2,099.25
|
| Rate for Payer: Networks By Design Commercial |
$1,819.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,379.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,880.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,951.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,679.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,679.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,721.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,721.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,721.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,721.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC MYOCARDIAL PERFUSION MULTIPLE TEST
|
Facility
|
IP
|
$2,799.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
909301383
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$559.80 |
| Max. Negotiated Rate |
$2,519.10 |
| Rate for Payer: Cash Price |
$1,259.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,239.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,119.60
|
| Rate for Payer: Galaxy Health WC |
$2,379.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,679.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,519.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,866.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,066.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$559.80
|
| Rate for Payer: Multiplan Commercial |
$2,099.25
|
| Rate for Payer: Networks By Design Commercial |
$1,819.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,379.15
|
|
|
HC MYOCARDIAL PERFUSION SINGLE
|
Facility
|
OP
|
$3,533.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301385
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$335.54 |
| Max. Negotiated Rate |
$3,179.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,774.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,374.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$812.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,087.30
|
| Rate for Payer: Blue Distinction Transplant |
$2,119.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,183.39
|
| Rate for Payer: Blue Shield of California EPN |
$1,717.04
|
| Rate for Payer: Caremore Medicare Advantage |
$1,774.15
|
| Rate for Payer: Cash Price |
$1,589.85
|
| Rate for Payer: Cash Price |
$1,589.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,826.40
|
| Rate for Payer: Cigna of CA HMO |
$2,261.12
|
| Rate for Payer: Cigna of CA PPO |
$2,614.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$3,003.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,119.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,179.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,649.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,909.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,927.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: InnovAge PACE Commercial |
$2,661.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,356.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,377.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$2,649.75
|
| Rate for Payer: Networks By Design Commercial |
$2,296.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,003.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,880.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,951.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,119.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,119.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,721.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,721.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,721.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,721.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC MYOCARDIAL PERFUSION SINGLE
|
Facility
|
IP
|
$3,533.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301385
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$706.60 |
| Max. Negotiated Rate |
$3,179.70 |
| Rate for Payer: Cash Price |
$1,589.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,826.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,413.20
|
| Rate for Payer: Galaxy Health WC |
$3,003.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,119.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,179.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,356.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,346.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.60
|
| Rate for Payer: Multiplan Commercial |
$2,649.75
|
| Rate for Payer: Networks By Design Commercial |
$2,296.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,003.05
|
|
|
HC MYOCARDIAL STRAIN IMAGING
|
Facility
|
IP
|
$2,434.00
|
|
|
Service Code
|
CPT 93356
|
| Hospital Charge Code |
900200356
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$486.80 |
| Max. Negotiated Rate |
$2,190.60 |
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,947.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$973.60
|
| Rate for Payer: Galaxy Health WC |
$2,068.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,460.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,190.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,623.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$927.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.80
|
| Rate for Payer: Multiplan Commercial |
$1,825.50
|
| Rate for Payer: Networks By Design Commercial |
$1,582.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.90
|
|
