|
HC BONE MARROW ASP ONLY
|
Facility
|
OP
|
$2,227.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
911800312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.35 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$445.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$1,002.15
|
| Rate for Payer: Cash Price |
$1,002.15
|
| Rate for Payer: Cash Price |
$1,002.15
|
| Rate for Payer: Cigna of CA HMO |
$1,425.28
|
| Rate for Payer: Cigna of CA PPO |
$1,647.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$1,892.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,336.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$308.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,485.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$1,781.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,447.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,892.95
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,336.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC BONE MARROW ASP ONLY
|
Facility
|
IP
|
$2,227.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
911800312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$445.40 |
| Max. Negotiated Rate |
$1,892.95 |
| Rate for Payer: Adventist Health Commercial |
$445.40
|
| Rate for Payer: Cash Price |
$1,002.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$890.80
|
| Rate for Payer: EPIC Health Plan Senior |
$890.80
|
| Rate for Payer: Galaxy Health WC |
$1,892.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,336.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,485.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,378.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.48
|
| Rate for Payer: Multiplan Commercial |
$1,781.60
|
| Rate for Payer: Networks By Design Commercial |
$1,447.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,892.95
|
|
|
HC BONE MARROW BX ONLY
|
Facility
|
OP
|
$3,588.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
909020057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.99 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$717.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$1,614.60
|
| Rate for Payer: Cash Price |
$1,614.60
|
| Rate for Payer: Cash Price |
$1,614.60
|
| Rate for Payer: Cigna of CA HMO |
$2,296.32
|
| Rate for Payer: Cigna of CA PPO |
$2,655.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$3,049.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,152.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$328.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,393.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$861.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$2,870.40
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,332.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,049.80
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,152.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC BONE MARROW BX ONLY
|
Facility
|
IP
|
$3,588.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
909020057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$717.60 |
| Max. Negotiated Rate |
$3,049.80 |
| Rate for Payer: Adventist Health Commercial |
$717.60
|
| Rate for Payer: Cash Price |
$1,614.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,435.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,435.20
|
| Rate for Payer: Galaxy Health WC |
$3,049.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,152.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,393.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,367.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,220.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$861.12
|
| Rate for Payer: Multiplan Commercial |
$2,870.40
|
| Rate for Payer: Networks By Design Commercial |
$2,332.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,049.80
|
|
|
HC BONE MARROW IMAGING, LTD
|
Facility
|
OP
|
$1,437.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
909301330
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$156.66 |
| Max. Negotiated Rate |
$1,221.45 |
| Rate for Payer: Adventist Health Commercial |
$287.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$942.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$882.46
|
| Rate for Payer: Blue Shield of California Commercial |
$879.44
|
| Rate for Payer: Blue Shield of California EPN |
$580.55
|
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: Cigna of CA HMO |
$919.68
|
| Rate for Payer: Cigna of CA PPO |
$1,063.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,221.45
|
| Rate for Payer: Global Benefits Group Commercial |
$862.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$958.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,149.60
|
| Rate for Payer: Networks By Design Commercial |
$934.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,221.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$862.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$862.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$654.98
|
| Rate for Payer: United Healthcare All Other HMO |
$654.98
|
| Rate for Payer: United Healthcare HMO Rider |
$654.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC BONE MARROW IMAGING, LTD
|
Facility
|
IP
|
$1,437.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
909301330
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$287.40 |
| Max. Negotiated Rate |
$1,221.45 |
| Rate for Payer: Adventist Health Commercial |
$287.40
|
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$574.80
|
| Rate for Payer: EPIC Health Plan Senior |
$574.80
|
| Rate for Payer: Galaxy Health WC |
$1,221.45
|
| Rate for Payer: Global Benefits Group Commercial |
$862.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$958.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$547.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$889.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.88
|
| Rate for Payer: Multiplan Commercial |
$1,149.60
|
| Rate for Payer: Networks By Design Commercial |
$934.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,221.45
|
|
|
HC BONE SCAN LIMITED
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
909301370
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$135.93 |
| Max. Negotiated Rate |
$1,551.25 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,197.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,120.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,116.90
|
| Rate for Payer: Blue Shield of California EPN |
$737.30
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Cigna of CA HMO |
$1,168.00
|
| Rate for Payer: Cigna of CA PPO |
$1,350.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,551.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,095.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,217.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,460.00
|
| Rate for Payer: Networks By Design Commercial |
$1,186.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,551.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,095.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,095.00
|
| 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: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC BONE SCAN LIMITED
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
909301370
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$365.00 |
| Max. Negotiated Rate |
$1,551.25 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$730.00
|
| Rate for Payer: Galaxy Health WC |
$1,551.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,095.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,217.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$695.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,129.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.00
|
| Rate for Payer: Multiplan Commercial |
$1,460.00
|
| Rate for Payer: Networks By Design Commercial |
$1,186.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,551.25
|
|
|
HC BONE SCAN WHOLE BODY
|
Facility
|
OP
|
$3,218.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
909301371
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$2,735.30 |
| Rate for Payer: Adventist Health Commercial |
$643.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,110.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,976.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,969.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.07
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cigna of CA HMO |
$2,059.52
|
| Rate for Payer: Cigna of CA PPO |
$2,381.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$2,735.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$236.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,146.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$2,574.40
|
| Rate for Payer: Networks By Design Commercial |
$2,091.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,930.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,930.80
|
| 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: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC BONE SCAN WHOLE BODY
|
Facility
|
IP
|
$3,218.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
909301371
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$643.60 |
| Max. Negotiated Rate |
$2,735.30 |
| Rate for Payer: Adventist Health Commercial |
$643.60
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,287.20
|
| Rate for Payer: Galaxy Health WC |
$2,735.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,146.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,226.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,991.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.32
|
| Rate for Payer: Multiplan Commercial |
$2,574.40
|
| Rate for Payer: Networks By Design Commercial |
$2,091.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
|
|
HC BONE SPECT
|
Facility
|
IP
|
$3,422.00
|
|
|
Service Code
|
CPT 78320
|
| Hospital Charge Code |
909301369
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$684.40 |
| Max. Negotiated Rate |
$2,908.70 |
| Rate for Payer: Adventist Health Commercial |
$684.40
|
| Rate for Payer: Cash Price |
$1,539.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,368.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,368.80
|
| Rate for Payer: Galaxy Health WC |
$2,908.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,053.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,282.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,303.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,118.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$821.28
|
| Rate for Payer: Multiplan Commercial |
$2,737.60
|
| Rate for Payer: Networks By Design Commercial |
$2,224.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,908.70
|
|
|
HC BONE SPECT
|
Facility
|
OP
|
$3,422.00
|
|
|
Service Code
|
CPT 78320
|
| Hospital Charge Code |
909301369
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$684.40 |
| Max. Negotiated Rate |
$2,908.70 |
| Rate for Payer: Adventist Health Commercial |
$684.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,244.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,908.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,882.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,566.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,101.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2,094.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,382.49
|
| Rate for Payer: Cash Price |
$1,539.90
|
| Rate for Payer: Cigna of CA HMO |
$2,190.08
|
| Rate for Payer: Cigna of CA PPO |
$2,532.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,908.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,908.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,908.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,368.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,368.80
|
| Rate for Payer: Galaxy Health WC |
$2,908.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,053.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,282.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,303.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,118.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$821.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,395.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,395.40
|
| Rate for Payer: Multiplan Commercial |
$2,737.60
|
| Rate for Payer: Networks By Design Commercial |
$2,224.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,908.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,053.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,053.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,711.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,711.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,711.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,908.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,908.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,908.70
|
|
|
HC BONE/STEM TRANS ALLOGENIC
|
Facility
|
OP
|
$6,498.00
|
|
|
Service Code
|
CPT 38240
|
| Hospital Charge Code |
907702201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$175.12 |
| Max. Negotiated Rate |
$123,239.83 |
| Rate for Payer: Adventist Health Commercial |
$1,299.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112,719.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75,146.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75,146.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,411.00
|
| Rate for Payer: Cash Price |
$2,924.10
|
| Rate for Payer: Cash Price |
$2,924.10
|
| Rate for Payer: Cash Price |
$2,924.10
|
| Rate for Payer: Cigna of CA HMO |
$4,158.72
|
| Rate for Payer: Cigna of CA PPO |
$4,808.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112,719.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$75,146.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75,146.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$101,447.42
|
| Rate for Payer: EPIC Health Plan Senior |
$75,146.24
|
| Rate for Payer: Galaxy Health WC |
$5,523.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,898.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$123,239.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75,146.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,334.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75,146.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,559.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94,684.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100,695.96
|
| Rate for Payer: Multiplan Commercial |
$5,198.40
|
| Rate for Payer: Multiplan WC |
$119,732.14
|
| Rate for Payer: Networks By Design Commercial |
$4,223.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,523.30
|
| Rate for Payer: Prime Health Services WC |
$118,510.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,898.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,898.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,249.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,249.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,249.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,249.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75,146.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112,719.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75,146.24
|
| Rate for Payer: Vantage Medical Group Senior |
$75,146.24
|
|
|
HC BONE/STEM TRANS ALLOGENIC
|
Facility
|
IP
|
$6,498.00
|
|
|
Service Code
|
CPT 38240
|
| Hospital Charge Code |
907702201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,299.60 |
| Max. Negotiated Rate |
$5,523.30 |
| Rate for Payer: Adventist Health Commercial |
$1,299.60
|
| Rate for Payer: Cash Price |
$2,924.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,599.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,599.20
|
| Rate for Payer: Galaxy Health WC |
$5,523.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,898.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,334.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,475.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,559.52
|
| Rate for Payer: Multiplan Commercial |
$5,198.40
|
| Rate for Payer: Networks By Design Commercial |
$4,223.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,523.30
|
|
|
HC BONE/STEM TRANS ALLOG LYMPH
|
Facility
|
OP
|
$5,538.00
|
|
|
Service Code
|
CPT 38242
|
| Hospital Charge Code |
907702205
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$133.85 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,107.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,632.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,082.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,082.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,492.10
|
| Rate for Payer: Cash Price |
$2,492.10
|
| Rate for Payer: Cash Price |
$2,492.10
|
| Rate for Payer: Cigna of CA HMO |
$3,544.32
|
| Rate for Payer: Cigna of CA PPO |
$4,098.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,082.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,811.87
|
| Rate for Payer: EPIC Health Plan Senior |
$2,082.87
|
| Rate for Payer: Galaxy Health WC |
$4,707.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,322.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,415.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,082.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,693.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,329.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,624.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.05
|
| Rate for Payer: Multiplan Commercial |
$4,430.40
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$3,599.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,707.30
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,322.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,322.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,769.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,769.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,769.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,769.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.87
|
|
|
HC BONE/STEM TRANS ALLOG LYMPH
|
Facility
|
IP
|
$5,538.00
|
|
|
Service Code
|
CPT 38242
|
| Hospital Charge Code |
907702205
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,107.60 |
| Max. Negotiated Rate |
$4,707.30 |
| Rate for Payer: Adventist Health Commercial |
$1,107.60
|
| Rate for Payer: Cash Price |
$2,492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,215.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,215.20
|
| Rate for Payer: Galaxy Health WC |
$4,707.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,322.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,693.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,109.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,428.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,329.12
|
| Rate for Payer: Multiplan Commercial |
$4,430.40
|
| Rate for Payer: Networks By Design Commercial |
$3,599.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,707.30
|
|
|
HC BONE/STEM TRANS AUTOLOGUS
|
Facility
|
OP
|
$5,998.00
|
|
|
Service Code
|
CPT 38241
|
| Hospital Charge Code |
907702202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$175.12 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,199.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,082.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,082.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,411.00
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cigna of CA HMO |
$3,838.72
|
| Rate for Payer: Cigna of CA PPO |
$4,438.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,082.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,811.87
|
| Rate for Payer: EPIC Health Plan Senior |
$2,082.87
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,415.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,082.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,000.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,439.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,624.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.05
|
| Rate for Payer: Multiplan Commercial |
$4,798.40
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$3,898.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,598.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,598.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,999.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,999.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,999.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,999.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.87
|
|
|
HC BONE/STEM TRANS AUTOLOGUS
|
Facility
|
IP
|
$5,998.00
|
|
|
Service Code
|
CPT 38241
|
| Hospital Charge Code |
907702202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,199.60 |
| Max. Negotiated Rate |
$5,098.30 |
| Rate for Payer: Adventist Health Commercial |
$1,199.60
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,399.20
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,000.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,285.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,712.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,439.52
|
| Rate for Payer: Multiplan Commercial |
$4,798.40
|
| Rate for Payer: Networks By Design Commercial |
$3,898.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
|
|
HC BONE SURVEY COMPLETE
|
Facility
|
IP
|
$2,127.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$425.40 |
| Max. Negotiated Rate |
$1,807.95 |
| Rate for Payer: Adventist Health Commercial |
$425.40
|
| Rate for Payer: Cash Price |
$957.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.80
|
| Rate for Payer: EPIC Health Plan Senior |
$850.80
|
| Rate for Payer: Galaxy Health WC |
$1,807.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,276.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,316.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.48
|
| Rate for Payer: Multiplan Commercial |
$1,701.60
|
| Rate for Payer: Networks By Design Commercial |
$1,382.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.95
|
|
|
HC BONE SURVEY COMPLETE
|
Facility
|
OP
|
$2,127.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.88 |
| Max. Negotiated Rate |
$1,807.95 |
| Rate for Payer: Adventist Health Commercial |
$425.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,395.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,301.72
|
| Rate for Payer: Blue Shield of California EPN |
$859.31
|
| Rate for Payer: Cash Price |
$957.15
|
| Rate for Payer: Cash Price |
$957.15
|
| Rate for Payer: Cigna of CA HMO |
$1,361.28
|
| Rate for Payer: Cigna of CA PPO |
$1,573.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,807.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,276.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,701.60
|
| Rate for Payer: Networks By Design Commercial |
$1,382.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,276.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,276.20
|
| 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: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC BONE SURVEY INFANT
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$127.20
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Networks By Design Commercial |
$206.70
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
|
|
HC BONE SURVEY INFANT
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.53
|
| Rate for Payer: Blue Shield of California Commercial |
$194.62
|
| Rate for Payer: Blue Shield of California EPN |
$128.47
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO |
$203.52
|
| Rate for Payer: Cigna of CA PPO |
$235.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Networks By Design Commercial |
$206.70
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC BONE WAX STERILE 2.5G
|
Facility
|
OP
|
$32.96
|
|
| Hospital Charge Code |
901698818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$28.02 |
| Rate for Payer: Adventist Health Commercial |
$6.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.24
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cigna of CA HMO |
$21.09
|
| Rate for Payer: Cigna of CA PPO |
$24.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.18
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$28.02
|
| Rate for Payer: Global Benefits Group Commercial |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.07
|
| Rate for Payer: Multiplan Commercial |
$26.37
|
| Rate for Payer: Networks By Design Commercial |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$28.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.48
|
| Rate for Payer: United Healthcare All Other HMO |
$16.48
|
| Rate for Payer: United Healthcare HMO Rider |
$16.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Vantage Medical Group Senior |
$28.02
|
|
|
HC BONE WAX STERILE 2.5G
|
Facility
|
IP
|
$32.96
|
|
| Hospital Charge Code |
901698818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$28.02 |
| Rate for Payer: Adventist Health Commercial |
$6.59
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.18
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$28.02
|
| Rate for Payer: Global Benefits Group Commercial |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.91
|
| Rate for Payer: Multiplan Commercial |
$26.37
|
| Rate for Payer: Networks By Design Commercial |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$28.02
|
|
|
HC BOOT CAST PEDS LG
|
Facility
|
OP
|
$114.99
|
|
| Hospital Charge Code |
901692802
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.74 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.62
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO |
$73.59
|
| Rate for Payer: Cigna of CA PPO |
$85.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.49
|
| Rate for Payer: Multiplan Commercial |
$91.99
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.49
|
| Rate for Payer: United Healthcare All Other HMO |
$57.49
|
| Rate for Payer: United Healthcare HMO Rider |
$57.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.74
|
| Rate for Payer: Vantage Medical Group Senior |
$97.74
|
|
