|
HC THYROID UPTAKE/SCAN
|
Facility
IP
|
$2,698.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
909301315
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$539.60 |
| Max. Negotiated Rate |
$2,428.20 |
| Rate for Payer: Cash Price |
$1,214.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,158.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,079.20
|
| Rate for Payer: Galaxy Health WC |
$2,293.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,618.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,428.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,799.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.60
|
| Rate for Payer: Multiplan Commercial |
$2,023.50
|
| Rate for Payer: Networks By Design Commercial |
$1,753.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,293.30
|
|
|
HC THYROXIN T4
|
Facility
IP
|
$138.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
900910835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Central Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
|
|
HC THYROXIN T4
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
900910835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$60.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.44
|
| 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 Exchange |
$50.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.99
|
| Rate for Payer: BCBS Transplant Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$6.87
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| 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: 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 Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.27
|
| Rate for Payer: IEHP medi-cal |
$11.34
|
| Rate for Payer: IEHP Medicare Advantage |
$6.87
|
| Rate for Payer: Innovage PACE Commercial |
$10.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$7.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: Riverside University Health MISP |
$7.56
|
| 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
|
$913.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
909001638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$821.70 |
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Central Health Plan Commercial |
$730.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.20
|
| Rate for Payer: Galaxy Health WC |
$776.05
|
| Rate for Payer: Global Benefits Group Commercial |
$547.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$821.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.60
|
| Rate for Payer: Multiplan Commercial |
$684.75
|
| Rate for Payer: Networks By Design Commercial |
$593.45
|
| Rate for Payer: Prime Health Services Commercial |
$776.05
|
|
|
HC TIBIA FIBULA
|
Facility
OP
|
$913.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
909001638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.93 |
| Max. Negotiated Rate |
$821.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.93
|
| 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 Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.50
|
| Rate for Payer: BCBS Transplant Transplant |
$547.80
|
| Rate for Payer: Blue Shield of California Commercial |
$564.23
|
| Rate for Payer: Blue Shield of California EPN |
$443.72
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Central Health Plan Commercial |
$730.40
|
| Rate for Payer: Cigna of CA HMO |
$584.32
|
| Rate for Payer: Cigna of CA PPO |
$675.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| 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 |
$776.05
|
| Rate for Payer: Global Benefits Group Commercial |
$547.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$821.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$684.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$684.75
|
| Rate for Payer: Networks By Design Commercial |
$593.45
|
| Rate for Payer: Prime Health Services Commercial |
$776.05
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$547.80
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$547.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$547.80
|
| 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 TIBIAL LENGTH SOCK
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT L2840
|
| Hospital Charge Code |
905352840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Blue Shield of California EPN |
$69.95
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Central Health Plan Commercial |
$104.80
|
| Rate for Payer: Cigna of CA HMO |
$91.70
|
| Rate for Payer: Cigna of CA PPO |
$91.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.20
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: Networks By Design Commercial |
$65.50
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
|
|
HC TIBIAL LENGTH SOCK
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT L2840
|
| Hospital Charge Code |
905352840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$181.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$181.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$72.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$72.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.39
|
| Rate for Payer: BCBS Transplant Transplant |
$78.60
|
| Rate for Payer: Blue Shield of California Commercial |
$98.25
|
| Rate for Payer: Blue Shield of California EPN |
$71.26
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Central Health Plan Commercial |
$104.80
|
| Rate for Payer: Cigna of CA HMO |
$91.70
|
| Rate for Payer: Cigna of CA PPO |
$91.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$98.25
|
| Rate for Payer: IEHP medi-cal |
$45.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.71
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: Networks By Design Commercial |
$65.50
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
| Rate for Payer: Riverside University Health MISP |
$52.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.50
|
| Rate for Payer: United Healthcare All Other HMO |
$65.50
|
| Rate for Payer: United Healthcare HMO Rider |
$65.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.35
|
| Rate for Payer: Vantage Medical Group Senior |
$111.35
|
|
|
HC TIG HUMAN INTRAMUSCULAR USE
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT 90389
|
| Hospital Charge Code |
902890180
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
|
|
HC TIG HUMAN INTRAMUSCULAR USE
|
Facility
OP
|
$160.00
|
|
|
Service Code
|
CPT 90389
|
| Hospital Charge Code |
902890180
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$3,944.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,944.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$96.00
|
| Rate for Payer: Blue Shield of California Commercial |
$100.64
|
| Rate for Payer: Blue Shield of California EPN |
$78.24
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$102.40
|
| Rate for Payer: Cigna of CA PPO |
$118.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$120.00
|
| Rate for Payer: IEHP medi-cal |
$56.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: Riverside University Health MISP |
$64.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.00
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$80.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC TILT TABLE TEST
|
Facility
OP
|
$3,784.00
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
900200144
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$400.05 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$669.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,832.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,235.59
|
| Rate for Payer: BCBS Transplant Transplant |
$2,270.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$669.68
|
| Rate for Payer: Cash Price |
$1,702.80
|
| Rate for Payer: Cash Price |
$1,702.80
|
| Rate for Payer: Cash Price |
$1,702.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,027.20
|
| Rate for Payer: Cigna of CA HMO |
$2,421.76
|
| Rate for Payer: Cigna of CA PPO |
$2,800.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$3,216.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,270.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,405.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,838.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,098.28
|
| Rate for Payer: IEHP medi-cal |
$1,104.97
|
| Rate for Payer: IEHP Medicare Advantage |
$669.68
|
| Rate for Payer: Innovage PACE Commercial |
$1,004.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$897.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$2,838.00
|
| Rate for Payer: Networks By Design Commercial |
$2,459.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,216.40
|
| Rate for Payer: Prime Health Services Medicare |
$709.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,270.40
|
| Rate for Payer: Riverside University Health MISP |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,270.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,270.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC TILT TABLE TEST
|
Facility
IP
|
$3,784.00
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
900200144
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$756.80 |
| Max. Negotiated Rate |
$3,405.60 |
| Rate for Payer: Cash Price |
$1,702.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,027.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,513.60
|
| Rate for Payer: Galaxy Health WC |
$3,216.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,270.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,405.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,523.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.80
|
| Rate for Payer: Multiplan Commercial |
$2,838.00
|
| Rate for Payer: Networks By Design Commercial |
$2,459.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,216.40
|
|
|
HC TIP ARGYLE YANKAUER SUCTN 12FR
|
Facility
OP
|
$4.35
|
|
| Hospital Charge Code |
901698614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.57
|
| Rate for Payer: BCBS Transplant Transplant |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2.74
|
| Rate for Payer: Blue Shield of California EPN |
$2.13
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Central Health Plan Commercial |
$3.48
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$3.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.26
|
| Rate for Payer: IEHP medi-cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$3.26
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.61
|
| Rate for Payer: Riverside University Health MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.18
|
| Rate for Payer: United Healthcare All Other HMO |
$2.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3.70
|
|
|
HC TIP ARGYLE YANKAUER SUCTN 12FR
|
Facility
IP
|
$4.35
|
|
| Hospital Charge Code |
901698614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Central Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$3.26
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
|
|
HC TIP DEFLECTING WIRE
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$108.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$108.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.98
|
| Rate for Payer: BCBS Transplant Transplant |
$118.80
|
| Rate for Payer: Blue Shield of California Commercial |
$124.54
|
| Rate for Payer: Blue Shield of California EPN |
$96.82
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$158.40
|
| Rate for Payer: Cigna of CA HMO |
$126.72
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$178.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$148.50
|
| Rate for Payer: IEHP medi-cal |
$69.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$118.80
|
| Rate for Payer: Riverside University Health MISP |
$79.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Vantage Medical Group Senior |
$168.30
|
|
|
HC TIP DEFLECTING WIRE
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$158.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$178.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
|
|
HC TIPS CATHETER SET
|
Facility
OP
|
$1,062.00
|
|
| Hospital Charge Code |
909081222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.40 |
| Max. Negotiated Rate |
$955.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$644.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$902.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$584.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$584.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$514.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$627.43
|
| Rate for Payer: BCBS Transplant Transplant |
$637.20
|
| Rate for Payer: Blue Shield of California Commercial |
$668.00
|
| Rate for Payer: Blue Shield of California EPN |
$519.32
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Central Health Plan Commercial |
$849.60
|
| Rate for Payer: Cigna of CA HMO |
$679.68
|
| Rate for Payer: Cigna of CA PPO |
$785.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$902.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$424.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$424.80
|
| Rate for Payer: Galaxy Health WC |
$902.70
|
| Rate for Payer: Global Benefits Group Commercial |
$637.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$955.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$796.50
|
| Rate for Payer: IEHP medi-cal |
$371.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$708.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.40
|
| Rate for Payer: Multiplan Commercial |
$796.50
|
| Rate for Payer: Networks By Design Commercial |
$690.30
|
| Rate for Payer: Prime Health Services Commercial |
$902.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$637.20
|
| Rate for Payer: Riverside University Health MISP |
$424.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$637.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$637.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$531.00
|
| Rate for Payer: United Healthcare All Other HMO |
$531.00
|
| Rate for Payer: United Healthcare HMO Rider |
$531.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$531.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$902.70
|
| Rate for Payer: Vantage Medical Group Senior |
$902.70
|
|
|
HC TIPS CATHETER SET
|
Facility
IP
|
$1,062.00
|
|
| Hospital Charge Code |
909081222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.40 |
| Max. Negotiated Rate |
$955.80 |
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Central Health Plan Commercial |
$849.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$424.80
|
| Rate for Payer: Galaxy Health WC |
$902.70
|
| Rate for Payer: Global Benefits Group Commercial |
$637.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$955.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$708.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.40
|
| Rate for Payer: Multiplan Commercial |
$796.50
|
| Rate for Payer: Networks By Design Commercial |
$690.30
|
| Rate for Payer: Prime Health Services Commercial |
$902.70
|
|
|
HC T.I.P.S. (PORTOCAVAL SHUNT)
|
Facility
IP
|
$10,997.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
909081331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,199.40 |
| Max. Negotiated Rate |
$9,897.30 |
| Rate for Payer: Cash Price |
$4,948.65
|
| Rate for Payer: Central Health Plan Commercial |
$8,797.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,398.80
|
| Rate for Payer: Galaxy Health WC |
$9,347.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,598.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,897.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,335.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,199.40
|
| Rate for Payer: Multiplan Commercial |
$8,247.75
|
| Rate for Payer: Networks By Design Commercial |
$7,148.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,347.45
|
|
|
HC T.I.P.S. (PORTOCAVAL SHUNT)
|
Facility
OP
|
$10,997.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
909081331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,199.40 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,347.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,048.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,048.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: BCBS Transplant Transplant |
$6,598.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$4,948.65
|
| Rate for Payer: Cash Price |
$4,948.65
|
| Rate for Payer: Central Health Plan Commercial |
$8,797.60
|
| Rate for Payer: Cigna of CA PPO |
$8,137.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,347.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,398.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,398.80
|
| Rate for Payer: Galaxy Health WC |
$9,347.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,598.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,897.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,247.75
|
| Rate for Payer: IEHP medi-cal |
$3,848.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,335.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,199.40
|
| Rate for Payer: Multiplan Commercial |
$8,247.75
|
| Rate for Payer: Networks By Design Commercial |
$7,148.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,347.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,598.20
|
| Rate for Payer: Riverside University Health MISP |
$4,398.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,598.20
|
| 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 Medi-Cal |
$9,347.45
|
| Rate for Payer: Vantage Medical Group Senior |
$9,347.45
|
|
|
HC TIPS TX SHEATH
|
Facility
OP
|
$291.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$247.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$160.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$160.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.92
|
| Rate for Payer: BCBS Transplant Transplant |
$174.60
|
| Rate for Payer: Blue Shield of California Commercial |
$183.04
|
| Rate for Payer: Blue Shield of California EPN |
$142.30
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Central Health Plan Commercial |
$232.80
|
| Rate for Payer: Cigna of CA HMO |
$186.24
|
| Rate for Payer: Cigna of CA PPO |
$215.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$116.40
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$218.25
|
| Rate for Payer: IEHP medi-cal |
$101.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.20
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$174.60
|
| Rate for Payer: Riverside University Health MISP |
$116.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.50
|
| Rate for Payer: United Healthcare All Other HMO |
$145.50
|
| Rate for Payer: United Healthcare HMO Rider |
$145.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$247.35
|
| Rate for Payer: Vantage Medical Group Senior |
$247.35
|
|
|
HC TIPS TX SHEATH
|
Facility
IP
|
$291.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Central Health Plan Commercial |
$232.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.40
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.20
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
|
|
HC TIP SUCTION YANKAUER REG CAP
|
Facility
IP
|
$4.10
|
|
| Hospital Charge Code |
901605747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.66
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
HC TIP SUCTION YANKAUER REG CAP
|
Facility
OP
|
$4.10
|
|
| Hospital Charge Code |
901605747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.42
|
| Rate for Payer: BCBS Transplant Transplant |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2.58
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.08
|
| Rate for Payer: IEHP medi-cal |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.66
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: Riverside University Health MISP |
$1.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
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 |
$59.40 |
| Max. Negotiated Rate |
$11,644.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$143.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$926.98
|
| 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 Exchange |
$780.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$951.48
|
| Rate for Payer: BCBS Transplant Transplant |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$183.55
|
| Rate for Payer: Blue Shield of California EPN |
$144.34
|
| Rate for Payer: Caremore Medicare Advantage |
$143.75
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Central Health Plan Commercial |
$237.60
|
| 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: 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 Management Network EPO/PPO |
$267.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$222.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$235.75
|
| Rate for Payer: IEHP medi-cal |
$237.19
|
| Rate for Payer: IEHP Medicare Advantage |
$143.75
|
| Rate for Payer: Innovage PACE Commercial |
$215.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$192.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.62
|
| Rate for Payer: Multiplan Commercial |
$222.75
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: Prime Health Services Medicare |
$152.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: Riverside University Health MISP |
$158.12
|
| 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 |
$11,644.20
|
| 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 |
$82.40 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Central Health Plan Commercial |
$329.60
|
| 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: Health Management Network EPO/PPO |
$370.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.40
|
| Rate for Payer: Multiplan Commercial |
$309.00
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
|
