|
HC THYROID SCAN
|
Facility
OP
|
$1,500.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
909301316
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$330.68 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$959.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$893.70
|
| Rate for Payer: BCBS Transplant Transplant |
$900.00
|
| Rate for Payer: Blue Shield of California Commercial |
$886.50
|
| Rate for Payer: Blue Shield of California EPN |
$703.50
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna of CA HMO |
$960.00
|
| Rate for Payer: Cigna of CA PPO |
$1,110.00
|
| 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 |
$1,275.00
|
| Rate for Payer: Global Benefits Group Commercial |
$900.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,125.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: IEHP Medi-Cal |
$834.82
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$834.82
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,000.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| 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 |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$975.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$900.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$900.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$900.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$384.10
|
| Rate for Payer: United Healthcare All Other HMO |
$384.10
|
| Rate for Payer: United Healthcare HMO Rider |
$384.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.10
|
| 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 THYROID SCAN
|
Facility
IP
|
$1,500.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
909301316
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.00
|
| Rate for Payer: Galaxy Health WC |
$1,275.00
|
| Rate for Payer: Global Benefits Group Commercial |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,000.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$571.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$975.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.00
|
|
|
HC THYROID UPTAKE MULT
|
Facility
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
909301311
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$240.72 |
| Max. Negotiated Rate |
$852.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$472.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$597.59
|
| Rate for Payer: BCBS Transplant Transplant |
$601.80
|
| Rate for Payer: Blue Shield of California Commercial |
$592.77
|
| Rate for Payer: Blue Shield of California EPN |
$470.41
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cigna of CA HMO |
$641.92
|
| Rate for Payer: Cigna of CA PPO |
$742.22
|
| 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 |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$752.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: IEHP Medi-Cal |
$834.82
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$834.82
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.72
|
| 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 |
$802.40
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$601.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.92
|
| Rate for Payer: United Healthcare All Other HMO |
$291.92
|
| Rate for Payer: United Healthcare HMO Rider |
$291.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.92
|
| 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 THYROID UPTAKE MULT
|
Facility
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
909301311
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$240.72 |
| Max. Negotiated Rate |
$852.55 |
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.20
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.72
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
|
|
HC THYROID UPTAKE/SCAN
|
Facility
OP
|
$2,840.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
909301315
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$405.65 |
| Max. Negotiated Rate |
$2,414.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,399.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,692.07
|
| Rate for Payer: BCBS Transplant Transplant |
$1,704.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,678.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,331.96
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna of CA HMO |
$1,817.60
|
| Rate for Payer: Cigna of CA PPO |
$2,101.60
|
| 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 |
$2,414.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,704.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,130.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: IEHP Medi-Cal |
$834.82
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$834.82
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,894.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.60
|
| 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 |
$2,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,846.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,414.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,704.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,704.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,704.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$596.32
|
| Rate for Payer: United Healthcare All Other HMO |
$596.32
|
| Rate for Payer: United Healthcare HMO Rider |
$596.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$596.32
|
| 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 THYROID UPTAKE/SCAN
|
Facility
IP
|
$2,840.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
909301315
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$681.60 |
| Max. Negotiated Rate |
$2,414.00 |
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,136.00
|
| Rate for Payer: Galaxy Health WC |
$2,414.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,704.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,894.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,082.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.60
|
| Rate for Payer: Multiplan Commercial |
$2,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,846.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,414.00
|
|
|
HC THYROXIN T4
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
900910835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.71
|
| Rate for Payer: BCBS Transplant Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.30
|
| Rate for Payer: Dignity Health Media |
$6.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.87
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$11.27
|
| Rate for Payer: IEHP Medi-Cal |
$11.13
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11.13
|
| Rate for Payer: IEHP Medicare Advantage |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.56
|
| Rate for Payer: United Healthcare All Other HMO |
$5.56
|
| Rate for Payer: United Healthcare HMO Rider |
$5.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: Vantage Medical Group Senior |
$6.87
|
|
|
HC TIBIA FIBULA
|
Facility
IP
|
$839.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
909001638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$201.36 |
| Max. Negotiated Rate |
$713.15 |
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$335.60
|
| Rate for Payer: Galaxy Health WC |
$713.15
|
| Rate for Payer: Global Benefits Group Commercial |
$503.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$559.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.36
|
| Rate for Payer: Multiplan Commercial |
$671.20
|
| Rate for Payer: Networks By Design Commercial |
$545.35
|
| Rate for Payer: Prime Health Services Commercial |
$713.15
|
|
|
HC TIBIA FIBULA
|
Facility
OP
|
$839.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
909001638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$713.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.24
|
| Rate for Payer: BCBS Transplant Transplant |
$503.40
|
| Rate for Payer: Blue Shield of California Commercial |
$495.85
|
| Rate for Payer: Blue Shield of California EPN |
$393.49
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cigna of CA HMO |
$536.96
|
| Rate for Payer: Cigna of CA PPO |
$620.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$713.15
|
| Rate for Payer: Global Benefits Group Commercial |
$503.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$629.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: IEHP Medi-Cal |
$183.93
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$183.93
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$559.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$671.20
|
| Rate for Payer: Networks By Design Commercial |
$545.35
|
| Rate for Payer: Prime Health Services Commercial |
$713.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$503.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$503.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$503.40
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC T.I.P.S. (PORTOCAVAL SHUNT)
|
Facility
IP
|
$12,647.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
909081331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,035.28 |
| Max. Negotiated Rate |
$10,749.95 |
| Rate for Payer: Cash Price |
$5,691.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,058.80
|
| Rate for Payer: Galaxy Health WC |
$10,749.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,588.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,435.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,818.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,035.28
|
| Rate for Payer: Multiplan Commercial |
$10,117.60
|
| Rate for Payer: Networks By Design Commercial |
$8,220.55
|
| Rate for Payer: Prime Health Services Commercial |
$10,749.95
|
|
|
HC T.I.P.S. (PORTOCAVAL SHUNT)
|
Facility
OP
|
$12,647.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
909081331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$207.06 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,749.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,955.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,955.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,588.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$5,691.15
|
| Rate for Payer: Cash Price |
$5,691.15
|
| Rate for Payer: Cigna of CA PPO |
$9,358.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,749.95
|
| Rate for Payer: Dignity Health Media |
$10,749.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,749.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,058.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,058.80
|
| Rate for Payer: Galaxy Health WC |
$10,749.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,588.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,485.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,435.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,035.28
|
| Rate for Payer: Multiplan Commercial |
$10,117.60
|
| Rate for Payer: Networks By Design Commercial |
$8,220.55
|
| Rate for Payer: Prime Health Services Commercial |
$10,749.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,588.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,588.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,749.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,749.95
|
| Rate for Payer: Vantage Medical Group Senior |
$10,749.95
|
|
|
HC TISS CUL NEO BONE MARROW BLD
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900918003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.28 |
| Max. Negotiated Rate |
$1,050.34 |
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,050.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$978.30
|
| Rate for Payer: BCBS Transplant Transplant |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$191.86
|
| Rate for Payer: Blue Shield of California EPN |
$152.06
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cigna of CA HMO |
$190.08
|
| Rate for Payer: Cigna of CA PPO |
$219.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Media |
$143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$143.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$143.75
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$222.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.75
|
| Rate for Payer: Heritage Provider Network Transplant |
$235.75
|
| Rate for Payer: IEHP Medi-Cal |
$232.88
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$232.88
|
| Rate for Payer: IEHP Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.62
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.44
|
| Rate for Payer: United Healthcare All Other HMO |
$116.44
|
| Rate for Payer: United Healthcare HMO Rider |
$116.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC TISS CUL NEO BONE MARROW BLD
|
Facility
IP
|
$412.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900918003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$98.88 |
| Max. Negotiated Rate |
$350.20 |
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.88
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
|
|
HC TISS CUL NEO SOLID TUMOR
|
Facility
OP
|
$302.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.48 |
| Max. Negotiated Rate |
$1,302.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,226.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,302.43
|
| Rate for Payer: BCBS Transplant Transplant |
$181.20
|
| Rate for Payer: Blue Shield of California Commercial |
$195.09
|
| Rate for Payer: Blue Shield of California EPN |
$154.62
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna of CA HMO |
$193.28
|
| Rate for Payer: Cigna of CA PPO |
$223.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Media |
$147.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$147.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$147.52
|
| Rate for Payer: Galaxy Health WC |
$256.70
|
| Rate for Payer: Global Benefits Group Commercial |
$181.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$226.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$241.93
|
| Rate for Payer: IEHP Medi-Cal |
$238.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$238.98
|
| Rate for Payer: IEHP Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.68
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: Networks By Design Commercial |
$196.30
|
| Rate for Payer: Prime Health Services Commercial |
$256.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$181.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.49
|
| Rate for Payer: United Healthcare All Other HMO |
$119.49
|
| Rate for Payer: United Healthcare HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC TISS CUL NEO SOLID TUMOR
|
Facility
IP
|
$419.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.56 |
| Max. Negotiated Rate |
$356.15 |
| Rate for Payer: Cash Price |
$188.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.60
|
| Rate for Payer: Galaxy Health WC |
$356.15
|
| Rate for Payer: Global Benefits Group Commercial |
$251.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$279.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.56
|
| Rate for Payer: Multiplan Commercial |
$335.20
|
| Rate for Payer: Networks By Design Commercial |
$272.35
|
| Rate for Payer: Prime Health Services Commercial |
$356.15
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
910408235
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$1,224.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,224.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,007.35
|
| Rate for Payer: BCBS Transplant Transplant |
$127.80
|
| Rate for Payer: Blue Shield of California Commercial |
$137.60
|
| Rate for Payer: Blue Shield of California EPN |
$109.06
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Media |
$150.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$150.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.30
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.49
|
| Rate for Payer: Heritage Provider Network Transplant |
$246.49
|
| Rate for Payer: IEHP Medi-Cal |
$243.49
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$243.49
|
| Rate for Payer: IEHP Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.28 |
| Max. Negotiated Rate |
$1,224.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,224.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,007.35
|
| Rate for Payer: BCBS Transplant Transplant |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$191.86
|
| Rate for Payer: Blue Shield of California EPN |
$152.06
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cigna of CA HMO |
$190.08
|
| Rate for Payer: Cigna of CA PPO |
$219.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Media |
$150.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$150.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.30
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$222.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.49
|
| Rate for Payer: Heritage Provider Network Transplant |
$246.49
|
| Rate for Payer: IEHP Medi-Cal |
$243.49
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$243.49
|
| Rate for Payer: IEHP Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
910408235
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
IP
|
$412.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$98.88 |
| Max. Negotiated Rate |
$350.20 |
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.88
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
|
|
HC TISS CUL NON-NEO LYMPHOCYTE
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.28 |
| Max. Negotiated Rate |
$968.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$968.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$902.38
|
| Rate for Payer: BCBS Transplant Transplant |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$191.86
|
| Rate for Payer: Blue Shield of California EPN |
$152.06
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cigna of CA HMO |
$190.08
|
| Rate for Payer: Cigna of CA PPO |
$219.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Media |
$116.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$116.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$116.49
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$222.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.04
|
| Rate for Payer: Heritage Provider Network Transplant |
$191.04
|
| Rate for Payer: IEHP Medi-Cal |
$188.71
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$188.71
|
| Rate for Payer: IEHP Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$146.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.36
|
| Rate for Payer: United Healthcare All Other HMO |
$94.36
|
| Rate for Payer: United Healthcare HMO Rider |
$94.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC TISS CUL NON-NEO LYMPHOCYTE
|
Facility
IP
|
$412.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$98.88 |
| Max. Negotiated Rate |
$350.20 |
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.88
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
IP
|
$412.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$98.88 |
| Max. Negotiated Rate |
$350.20 |
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.88
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.28 |
| Max. Negotiated Rate |
$1,170.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,170.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,089.97
|
| Rate for Payer: BCBS Transplant Transplant |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$191.86
|
| Rate for Payer: Blue Shield of California EPN |
$152.06
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cigna of CA HMO |
$190.08
|
| Rate for Payer: Cigna of CA PPO |
$219.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.10
|
| Rate for Payer: Dignity Health Media |
$140.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$140.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.73
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$222.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$230.80
|
| Rate for Payer: Heritage Provider Network Transplant |
$230.80
|
| Rate for Payer: IEHP Medi-Cal |
$227.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$227.98
|
| Rate for Payer: IEHP Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$53.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.68
|
| Rate for Payer: BCBS Transplant Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$14.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.26
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.82
|
| Rate for Payer: Dignity Health Media |
$5.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.88
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.64
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.64
|
| Rate for Payer: IEHP Medi-Cal |
$9.53
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$9.53
|
| Rate for Payer: IEHP Medicare Advantage |
$5.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.88
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.76
|
| Rate for Payer: United Healthcare HMO Rider |
$4.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$5.88
|
|
|
HC T & L JUNCTION AP AND LATERAL
|
Facility
IP
|
$958.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
909001312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.92 |
| Max. Negotiated Rate |
$814.30 |
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.20
|
| Rate for Payer: Galaxy Health WC |
$814.30
|
| Rate for Payer: Global Benefits Group Commercial |
$574.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.92
|
| Rate for Payer: Multiplan Commercial |
$766.40
|
| Rate for Payer: Networks By Design Commercial |
$622.70
|
| Rate for Payer: Prime Health Services Commercial |
$814.30
|
|
