|
HC MUMPS ANTIBODY
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913663
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$105.00
|
| Rate for Payer: Blue Shield of California EPN |
$84.22
|
| Rate for Payer: Blue Shield of California EPN |
$84.22
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$65.00
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$50.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.05
|
| Rate for Payer: TriValley Medical Group Senior |
$13.05
|
| Rate for Payer: TriValley Medical Group Senior |
$13.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC MUMPS ANTIBODY
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913663
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC MUSCLE BIOPSY, PERCUTANEOUS
|
Facility
|
OP
|
$1,996.00
|
|
|
Service Code
|
CPT 20206
|
| Hospital Charge Code |
909000105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$361.28 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$399.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,233.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,297.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,235.52
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$1,497.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC MUSCLE BIOPSY, PERCUTANEOUS
|
Facility
|
IP
|
$1,996.00
|
|
|
Service Code
|
CPT 20206
|
| Hospital Charge Code |
909000105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$361.28 |
| Max. Negotiated Rate |
$1,497.00 |
| Rate for Payer: Adventist Health Commercial |
$399.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,285.42
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,351.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,351.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.00
|
| Rate for Payer: Multiplan Commercial |
$1,497.00
|
|
|
HC MUSCLE TEST MANUAL W RPT
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
900895831
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$326.25 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$280.14
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.50
|
| Rate for Payer: Heritage Provider Network Senior |
$294.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.75
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
|
|
HC MUSCLE TEST MANUAL W RPT
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
900895831
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$268.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.59
|
| Rate for Payer: Blue Shield of California Commercial |
$265.35
|
| Rate for Payer: Blue Shield of California EPN |
$212.28
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$282.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.26
|
| Rate for Payer: Heritage Provider Network Senior |
$269.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$207.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$522.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$437.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC MYELOAB
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913707
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.74
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.60
|
| Rate for Payer: Heritage Provider Network Senior |
$17.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
|
|
HC MYELOAB
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913707
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| 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 Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| 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 Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC MYELOGRAM, CERVICAL
|
Facility
|
IP
|
$2,446.00
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
909001363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$442.73 |
| Max. Negotiated Rate |
$1,834.50 |
| Rate for Payer: Adventist Health Commercial |
$489.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,575.22
|
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,655.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1,655.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$442.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.50
|
| Rate for Payer: Multiplan Commercial |
$1,834.50
|
|
|
HC MYELOGRAM, CERVICAL
|
Facility
|
OP
|
$2,446.00
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
909001363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$442.73 |
| Max. Negotiated Rate |
$1,834.50 |
| Rate for Payer: Adventist Health Commercial |
$489.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,511.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,282.91
|
| Rate for Payer: Blue Shield of California Commercial |
$999.65
|
| Rate for Payer: Blue Shield of California EPN |
$803.88
|
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,589.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,443.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,008.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,514.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1,514.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,166.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$442.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Multiplan Commercial |
$1,834.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,008.25
|
| Rate for Payer: TriValley Medical Group Senior |
$1,008.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$790.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$790.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
|
|
HC MYELOGRAM, COMPLETE
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
909001364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$346.62 |
| Max. Negotiated Rate |
$1,436.25 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,233.26
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,296.45
|
| Rate for Payer: Heritage Provider Network Senior |
$1,296.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$346.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.75
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
|
|
HC MYELOGRAM, COMPLETE
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
909001364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$346.62 |
| Max. Negotiated Rate |
$1,648.48 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,183.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,648.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1,283.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,032.47
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,244.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,129.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,008.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,185.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,185.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$913.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$346.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,008.25
|
| Rate for Payer: TriValley Medical Group Senior |
$1,008.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$790.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$790.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
|
|
HC MYELOGRAPHY LUMBAR INJECT 2 OR GT LVLS
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
909062305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$403.99 |
| Max. Negotiated Rate |
$1,674.00 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,437.41
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,511.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,511.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$403.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.00
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
|
|
HC MYELOGRAPHY LUMBAR INJECT 2 OR GT LVLS
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
909062305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$403.99 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,379.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,450.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,339.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,008.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,381.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1,240.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,915.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$403.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: Multiplan WC |
$1,599.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,109.08
|
| Rate for Payer: TriValley Medical Group Senior |
$1,109.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
|
|
HC MYELOGRAPHY LUMBAR INJECT C-SPINE
|
Facility
|
IP
|
$1,916.00
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
909062302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$346.80 |
| Max. Negotiated Rate |
$1,437.00 |
| Rate for Payer: Adventist Health Commercial |
$383.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,233.90
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,297.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,297.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$346.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.00
|
| Rate for Payer: Multiplan Commercial |
$1,437.00
|
|
|
HC MYELOGRAPHY LUMBAR INJECT C-SPINE
|
Facility
|
OP
|
$1,916.00
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
909062302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$346.80 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$383.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,184.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,245.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,149.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,008.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,186.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,240.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,915.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$346.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Multiplan Commercial |
$1,437.00
|
| Rate for Payer: Multiplan WC |
$1,599.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,109.08
|
| Rate for Payer: TriValley Medical Group Senior |
$1,109.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
|
|
HC MYELOGRAPHY LUMBAR INJECT L-SPINE
|
Facility
|
IP
|
$3,621.00
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
909062304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.40 |
| Max. Negotiated Rate |
$2,715.75 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,331.92
|
| Rate for Payer: Cash Price |
$1,629.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,451.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2,451.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$655.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.25
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
|
|
HC MYELOGRAPHY LUMBAR INJECT L-SPINE
|
Facility
|
OP
|
$3,621.00
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
909062304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.40 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,237.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,629.45
|
| Rate for Payer: Cash Price |
$1,629.45
|
| Rate for Payer: Cash Price |
$1,629.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,353.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,172.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,008.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,241.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,240.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,915.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$655.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
| Rate for Payer: Multiplan WC |
$1,599.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,109.08
|
| Rate for Payer: TriValley Medical Group Senior |
$1,109.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
|
|
HC MYELOGRAPHY LUMBAR INJECT T-SPINE
|
Facility
|
IP
|
$3,621.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
909062303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.40 |
| Max. Negotiated Rate |
$2,715.75 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,331.92
|
| Rate for Payer: Cash Price |
$1,629.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,451.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2,451.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$655.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.25
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
|
|
HC MYELOGRAPHY LUMBAR INJECT T-SPINE
|
Facility
|
OP
|
$3,621.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
909062303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.40 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,237.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,629.45
|
| Rate for Payer: Cash Price |
$1,629.45
|
| Rate for Payer: Cash Price |
$1,629.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,353.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,172.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,008.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,241.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,240.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,915.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$655.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
| Rate for Payer: Multiplan WC |
$1,599.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,109.08
|
| Rate for Payer: TriValley Medical Group Senior |
$1,109.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
|
|
HC MYELOGRAPHY, LUMBOSACRAL
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
909001372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$257.02 |
| Max. Negotiated Rate |
$1,065.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$914.48
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$961.34
|
| Rate for Payer: Heritage Provider Network Senior |
$961.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
|
|
HC MYELOGRAPHY, LUMBOSACRAL
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
909001372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$257.02 |
| Max. Negotiated Rate |
$1,512.38 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$877.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,101.63
|
| Rate for Payer: Blue Shield of California Commercial |
$857.95
|
| Rate for Payer: Blue Shield of California EPN |
$689.94
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$923.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$837.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,008.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$878.98
|
| Rate for Payer: Heritage Provider Network Senior |
$878.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$677.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,008.25
|
| Rate for Payer: TriValley Medical Group Senior |
$1,008.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$790.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$790.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
|
|
HC MYELOGRAPHY, THORACIC
|
Facility
|
IP
|
$2,115.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
909001371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$382.81 |
| Max. Negotiated Rate |
$1,586.25 |
| Rate for Payer: Adventist Health Commercial |
$423.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,362.06
|
| Rate for Payer: Cash Price |
$951.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,431.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,431.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$382.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.75
|
| Rate for Payer: Multiplan Commercial |
$1,586.25
|
|
|
HC MYELOGRAPHY, THORACIC
|
Facility
|
OP
|
$2,115.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
909001371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$382.81 |
| Max. Negotiated Rate |
$1,586.25 |
| Rate for Payer: Adventist Health Commercial |
$423.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,307.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,171.05
|
| Rate for Payer: Blue Shield of California Commercial |
$908.45
|
| Rate for Payer: Blue Shield of California EPN |
$730.54
|
| Rate for Payer: Cash Price |
$951.75
|
| Rate for Payer: Cash Price |
$951.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,374.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,247.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,008.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,309.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,309.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,008.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$382.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Multiplan Commercial |
$1,586.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,008.25
|
| Rate for Payer: TriValley Medical Group Senior |
$1,008.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$790.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$790.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
|
|
HC MYLOPEROXIDASE AB
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913678
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.23
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.81
|
| Rate for Payer: Heritage Provider Network Senior |
$52.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
|
