|
HC BONE, FINE NEEDLE ASPIRATION
|
Facility
|
IP
|
$1,703.00
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
909020019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$408.72 |
| Max. Negotiated Rate |
$1,447.55 |
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$681.20
|
| Rate for Payer: Galaxy Health WC |
$1,447.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.72
|
| Rate for Payer: Multiplan Commercial |
$1,362.40
|
| Rate for Payer: Networks By Design Commercial |
$1,106.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,447.55
|
|
|
HC BONE, FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$1,703.00
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
909020019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,021.80
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cigna of CA PPO |
$1,260.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,447.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,277.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,362.40
|
| Rate for Payer: Networks By Design Commercial |
$1,106.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,447.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,021.80
|
| 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 |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BONE LENGTH
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
909001603
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.90 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.20
|
| Rate for Payer: Blue Distinction Transplant |
$684.00
|
| Rate for Payer: Blue Shield of California Commercial |
$673.74
|
| Rate for Payer: Blue Shield of California EPN |
$534.66
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna of CA HMO |
$729.60
|
| Rate for Payer: Cigna of CA PPO |
$843.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$855.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$760.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$741.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$684.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC BONE LENGTH
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
909001603
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.60 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$760.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$741.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
|
|
HC BONE MARROW ASP/AT TIME OF BX
|
Facility
|
IP
|
$3,671.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
911800314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$881.04 |
| Max. Negotiated Rate |
$3,120.35 |
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.40
|
| Rate for Payer: Galaxy Health WC |
$3,120.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,202.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,448.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,398.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$881.04
|
| Rate for Payer: Multiplan Commercial |
$2,936.80
|
| Rate for Payer: Networks By Design Commercial |
$2,386.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,120.35
|
|
|
HC BONE MARROW ASP/AT TIME OF BX
|
Facility
|
OP
|
$3,671.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
911800314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.98 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,202.60
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cigna of CA PPO |
$2,716.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Galaxy Health WC |
$3,120.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,202.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,753.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,822.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$5,822.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,751.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5,751.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,448.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$881.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Multiplan Commercial |
$2,936.80
|
| Rate for Payer: Networks By Design Commercial |
$2,386.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,120.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,202.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC BONE MARROW ASP ONLY
|
Facility
|
IP
|
$2,279.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
911800312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$546.96 |
| Max. Negotiated Rate |
$1,937.15 |
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.60
|
| Rate for Payer: Galaxy Health WC |
$1,937.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,367.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,520.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$868.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.96
|
| Rate for Payer: Multiplan Commercial |
$1,823.20
|
| Rate for Payer: Networks By Design Commercial |
$1,481.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,937.15
|
|
|
HC BONE MARROW ASP ONLY
|
Facility
|
OP
|
$2,279.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
911800312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.73 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,367.40
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Cigna of CA PPO |
$1,686.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$1,937.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,367.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,709.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,520.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$1,823.20
|
| Rate for Payer: Networks By Design Commercial |
$1,481.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,937.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,367.40
|
| 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 |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BONE MARROW BX ONLY
|
Facility
|
IP
|
$3,671.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
909020057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$881.04 |
| Max. Negotiated Rate |
$3,120.35 |
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.40
|
| Rate for Payer: Galaxy Health WC |
$3,120.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,202.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,448.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,398.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$881.04
|
| Rate for Payer: Multiplan Commercial |
$2,936.80
|
| Rate for Payer: Networks By Design Commercial |
$2,386.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,120.35
|
|
|
HC BONE MARROW BX ONLY
|
Facility
|
OP
|
$3,671.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
909020057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$372.08 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,202.60
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cigna of CA PPO |
$2,716.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$3,120.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,202.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,753.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,448.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$881.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$2,936.80
|
| Rate for Payer: Networks By Design Commercial |
$2,386.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,120.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,202.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BONE MARROW IMAGING, LTD
|
Facility
|
IP
|
$1,691.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
909301330
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$405.84 |
| Max. Negotiated Rate |
$1,437.35 |
| Rate for Payer: Cash Price |
$760.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.40
|
| Rate for Payer: Galaxy Health WC |
$1,437.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.84
|
| Rate for Payer: Multiplan Commercial |
$1,352.80
|
| Rate for Payer: Networks By Design Commercial |
$1,099.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,437.35
|
|
|
HC BONE MARROW IMAGING, LTD
|
Facility
|
OP
|
$1,691.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
909301330
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$177.18 |
| Max. Negotiated Rate |
$1,437.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$886.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,007.50
|
| Rate for Payer: Blue Distinction Transplant |
$1,014.60
|
| Rate for Payer: Blue Shield of California Commercial |
$999.38
|
| Rate for Payer: Blue Shield of California EPN |
$793.08
|
| Rate for Payer: Cash Price |
$760.95
|
| Rate for Payer: Cash Price |
$760.95
|
| Rate for Payer: Cigna of CA HMO |
$1,082.24
|
| Rate for Payer: Cigna of CA PPO |
$1,251.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,437.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,268.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,352.80
|
| Rate for Payer: Networks By Design Commercial |
$1,099.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,437.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,014.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,014.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$654.98
|
| Rate for Payer: United Healthcare All Other HMO |
$654.98
|
| Rate for Payer: United Healthcare HMO Rider |
$654.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC BONE SCAN LIMITED
|
Facility
|
OP
|
$2,147.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
909301370
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$153.73 |
| Max. Negotiated Rate |
$1,824.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$923.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,279.18
|
| Rate for Payer: Blue Distinction Transplant |
$1,288.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,268.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,006.94
|
| Rate for Payer: Cash Price |
$966.15
|
| Rate for Payer: Cash Price |
$966.15
|
| Rate for Payer: Cigna of CA HMO |
$1,374.08
|
| Rate for Payer: Cigna of CA PPO |
$1,588.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,824.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,288.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,610.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,432.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,717.60
|
| Rate for Payer: Networks By Design Commercial |
$1,395.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,824.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,288.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,288.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.16
|
| Rate for Payer: United Healthcare All Other HMO |
$632.16
|
| Rate for Payer: United Healthcare HMO Rider |
$632.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC BONE SCAN LIMITED
|
Facility
|
IP
|
$2,147.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
909301370
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$515.28 |
| Max. Negotiated Rate |
$1,824.95 |
| Rate for Payer: Cash Price |
$966.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$858.80
|
| Rate for Payer: Galaxy Health WC |
$1,824.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,288.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,432.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$818.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.28
|
| Rate for Payer: Multiplan Commercial |
$1,717.60
|
| Rate for Payer: Networks By Design Commercial |
$1,395.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,824.95
|
|
|
HC BONE SCAN WHOLE BODY
|
Facility
|
IP
|
$3,786.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
909301371
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$908.64 |
| Max. Negotiated Rate |
$3,218.10 |
| Rate for Payer: Cash Price |
$1,703.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,514.40
|
| Rate for Payer: Galaxy Health WC |
$3,218.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,271.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,525.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,442.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.64
|
| Rate for Payer: Multiplan Commercial |
$3,028.80
|
| Rate for Payer: Networks By Design Commercial |
$2,460.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,218.10
|
|
|
HC BONE SCAN WHOLE BODY
|
Facility
|
OP
|
$3,786.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
909301371
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$267.96 |
| Max. Negotiated Rate |
$3,218.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,340.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,255.70
|
| Rate for Payer: Blue Distinction Transplant |
$2,271.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,237.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,775.63
|
| Rate for Payer: Cash Price |
$1,703.70
|
| Rate for Payer: Cash Price |
$1,703.70
|
| Rate for Payer: Cigna of CA HMO |
$2,423.04
|
| Rate for Payer: Cigna of CA PPO |
$2,801.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$3,218.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,271.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,839.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,525.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$3,028.80
|
| Rate for Payer: Networks By Design Commercial |
$2,460.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,218.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,271.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,271.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.16
|
| Rate for Payer: United Healthcare All Other HMO |
$632.16
|
| Rate for Payer: United Healthcare HMO Rider |
$632.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC BONE/STEM TRANS ALLOGENIC
|
Facility
|
OP
|
$8,048.00
|
|
|
Service Code
|
CPT 38240
|
| Hospital Charge Code |
907702201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$198.06 |
| Max. Negotiated Rate |
$111,973.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102,414.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75,104.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68,276.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,539.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,828.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,931.38
|
| Rate for Payer: Blue Shield of California EPN |
$4,700.03
|
| Rate for Payer: Cash Price |
$3,621.60
|
| Rate for Payer: Cash Price |
$3,621.60
|
| Rate for Payer: Cigna of CA HMO |
$5,150.72
|
| Rate for Payer: Cigna of CA PPO |
$5,955.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102,414.68
|
| Rate for Payer: Dignity Health Media |
$68,276.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$68,276.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$92,173.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$68,276.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$68,276.45
|
| Rate for Payer: Galaxy Health WC |
$6,840.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,828.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,036.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111,973.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$111,973.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110,607.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$110,607.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68,276.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,368.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68,276.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,931.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86,028.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91,490.44
|
| Rate for Payer: Multiplan Commercial |
$6,438.40
|
| Rate for Payer: Multiplan WC |
$93,343.67
|
| Rate for Payer: Networks By Design Commercial |
$5,231.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,840.80
|
| Rate for Payer: Prime Health Services WC |
$92,391.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,828.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,828.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,024.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,024.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,024.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102,414.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68,276.45
|
| Rate for Payer: Vantage Medical Group Senior |
$68,276.45
|
|
|
HC BONE/STEM TRANS ALLOGENIC
|
Facility
|
IP
|
$8,048.00
|
|
|
Service Code
|
CPT 38240
|
| Hospital Charge Code |
907702201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,931.52 |
| Max. Negotiated Rate |
$6,840.80 |
| Rate for Payer: Cash Price |
$3,621.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,219.20
|
| Rate for Payer: Galaxy Health WC |
$6,840.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,828.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,368.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,066.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,931.52
|
| Rate for Payer: Multiplan Commercial |
$6,438.40
|
| Rate for Payer: Networks By Design Commercial |
$5,231.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,840.80
|
|
|
HC BONE/STEM TRANS ALLOG LYMPH
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
CPT 38242
|
| Hospital Charge Code |
907702205
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,359.60 |
| Max. Negotiated Rate |
$4,815.25 |
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,266.00
|
| Rate for Payer: Galaxy Health WC |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,778.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,158.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.60
|
| Rate for Payer: Multiplan Commercial |
$4,532.00
|
| Rate for Payer: Networks By Design Commercial |
$3,682.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
|
|
HC BONE/STEM TRANS ALLOG LYMPH
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
CPT 38242
|
| Hospital Charge Code |
907702205
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$151.37 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$589.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,399.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,175.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,308.36
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Cigna of CA HMO |
$3,625.60
|
| Rate for Payer: Cigna of CA PPO |
$4,192.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,248.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,143.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,778.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,415.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$4,532.00
|
| Rate for Payer: Networks By Design Commercial |
$3,682.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,399.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,399.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,832.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,832.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,832.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,832.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,917.03
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC BONE/STEM TRANS AUTOLOGUS
|
Facility
|
IP
|
$7,429.00
|
|
|
Service Code
|
CPT 38241
|
| Hospital Charge Code |
907702202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,782.96 |
| Max. Negotiated Rate |
$6,314.65 |
| Rate for Payer: Cash Price |
$3,343.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,971.60
|
| Rate for Payer: Galaxy Health WC |
$6,314.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,457.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,955.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,830.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.96
|
| Rate for Payer: Multiplan Commercial |
$5,943.20
|
| Rate for Payer: Networks By Design Commercial |
$4,828.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,314.65
|
|
|
HC BONE/STEM TRANS AUTOLOGUS
|
Facility
|
OP
|
$7,429.00
|
|
|
Service Code
|
CPT 38241
|
| Hospital Charge Code |
907702202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$198.06 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,539.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,457.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,475.17
|
| Rate for Payer: Blue Shield of California EPN |
$4,338.54
|
| Rate for Payer: Cash Price |
$3,343.05
|
| Rate for Payer: Cash Price |
$3,343.05
|
| Rate for Payer: Cigna of CA HMO |
$4,754.56
|
| Rate for Payer: Cigna of CA PPO |
$5,497.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$6,314.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,457.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,571.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,143.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,955.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,415.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$5,943.20
|
| Rate for Payer: Networks By Design Commercial |
$4,828.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,314.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,457.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,457.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,714.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,714.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,714.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,714.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,917.03
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC BONE SURVEY COMPLETE
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$600.48 |
| Max. Negotiated Rate |
$2,126.70 |
| Rate for Payer: Cash Price |
$1,125.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.80
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$953.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.48
|
| Rate for Payer: Multiplan Commercial |
$2,001.60
|
| Rate for Payer: Networks By Design Commercial |
$1,626.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
|
|
HC BONE SURVEY COMPLETE
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,126.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$481.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$376.65
|
| Rate for Payer: Blue Distinction Transplant |
$1,501.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,478.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,173.44
|
| Rate for Payer: Cash Price |
$1,125.90
|
| Rate for Payer: Cash Price |
$1,125.90
|
| Rate for Payer: Cigna of CA HMO |
$1,601.28
|
| Rate for Payer: Cigna of CA PPO |
$1,851.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,876.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$2,001.60
|
| Rate for Payer: Networks By Design Commercial |
$1,626.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,501.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,501.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC BONE SURVEY INFANT
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$423.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$423.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.55
|
| Rate for Payer: Blue Distinction Transplant |
$224.40
|
| Rate for Payer: Blue Shield of California Commercial |
$221.03
|
| Rate for Payer: Blue Shield of California EPN |
$175.41
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$280.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$299.20
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
