|
HC BONE MARROW IMAGING, LTD
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
909301330
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$160.39 |
| Max. Negotiated Rate |
$1,167.30 |
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$885.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$754.46
|
| Rate for Payer: Blue Shield of California Commercial |
$817.11
|
| Rate for Payer: Blue Shield of California EPN |
$514.91
|
| Rate for Payer: Cash Price |
$583.65
|
| Rate for Payer: Cash Price |
$583.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,037.60
|
| Rate for Payer: Cigna of CA HMO |
$830.08
|
| Rate for Payer: Cigna of CA PPO |
$959.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$907.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,102.45
|
| Rate for Payer: Global Benefits Group Commercial |
$778.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,167.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$823.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$177.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
| Rate for Payer: Networks By Design Commercial |
$843.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$1,102.45
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$778.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$778.20
|
| 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 |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC BONE SCAN LIMITED
|
Facility
|
OP
|
$1,647.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
909301370
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$139.17 |
| Max. Negotiated Rate |
$1,482.30 |
| Rate for Payer: Adventist Health Commercial |
$329.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$922.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$506.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$958.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,037.61
|
| Rate for Payer: Blue Shield of California EPN |
$653.86
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,317.60
|
| Rate for Payer: Cigna of CA HMO |
$1,054.08
|
| Rate for Payer: Cigna of CA PPO |
$1,218.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,152.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,399.95
|
| Rate for Payer: Global Benefits Group Commercial |
$988.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,482.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$139.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,045.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,235.25
|
| Rate for Payer: Networks By Design Commercial |
$1,070.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.95
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$988.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$988.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.16
|
| Rate for Payer: United Healthcare All Other HMO |
$632.16
|
| Rate for Payer: United Healthcare HMO Rider |
$632.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC BONE SCAN LIMITED
|
Facility
|
IP
|
$1,647.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
909301370
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$329.40 |
| Max. Negotiated Rate |
$1,482.30 |
| Rate for Payer: Adventist Health Commercial |
$329.40
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,317.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,152.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.80
|
| Rate for Payer: EPIC Health Plan Senior |
$658.80
|
| Rate for Payer: Galaxy Health WC |
$1,399.95
|
| Rate for Payer: Global Benefits Group Commercial |
$988.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,482.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,045.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$971.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.40
|
| Rate for Payer: Multiplan Commercial |
$1,235.25
|
| Rate for Payer: Networks By Design Commercial |
$1,070.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.95
|
|
|
HC BONE SCAN WHOLE BODY
|
Facility
|
OP
|
$2,904.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
909301371
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$242.57 |
| Max. Negotiated Rate |
$2,613.60 |
| Rate for Payer: Adventist Health Commercial |
$580.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,339.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$867.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,689.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,829.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,152.89
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,323.20
|
| Rate for Payer: Cigna of CA HMO |
$1,858.56
|
| Rate for Payer: Cigna of CA PPO |
$2,148.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,032.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$2,468.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,742.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,613.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$242.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,844.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$267.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$2,178.00
|
| Rate for Payer: Networks By Design Commercial |
$1,887.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$2,468.40
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,742.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,742.40
|
| 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 |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC BONE SCAN WHOLE BODY
|
Facility
|
IP
|
$2,904.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
909301371
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$580.80 |
| Max. Negotiated Rate |
$2,613.60 |
| Rate for Payer: Adventist Health Commercial |
$580.80
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,323.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,032.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,161.60
|
| Rate for Payer: Galaxy Health WC |
$2,468.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,742.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,613.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,844.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,713.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.80
|
| Rate for Payer: Multiplan Commercial |
$2,178.00
|
| Rate for Payer: Networks By Design Commercial |
$1,887.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,468.40
|
|
|
HC BONE SPECT
|
Facility
|
IP
|
$3,089.00
|
|
|
Service Code
|
CPT 78320
|
| Hospital Charge Code |
909301369
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$617.80 |
| Max. Negotiated Rate |
$2,780.10 |
| Rate for Payer: Adventist Health Commercial |
$617.80
|
| Rate for Payer: Cash Price |
$1,390.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,471.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,162.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,235.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,235.60
|
| Rate for Payer: Galaxy Health WC |
$2,625.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,853.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,780.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,961.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,822.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.80
|
| Rate for Payer: Multiplan Commercial |
$2,316.75
|
| Rate for Payer: Networks By Design Commercial |
$2,007.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,625.65
|
|
|
HC BONE SPECT
|
Facility
|
OP
|
$3,089.00
|
|
|
Service Code
|
CPT 78320
|
| Hospital Charge Code |
909301369
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$617.80 |
| Max. Negotiated Rate |
$2,780.10 |
| Rate for Payer: Adventist Health Commercial |
$617.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,875.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,625.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,698.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,316.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,194.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,796.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,946.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,226.33
|
| Rate for Payer: Cash Price |
$1,390.05
|
| Rate for Payer: Cash Price |
$1,390.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,471.20
|
| Rate for Payer: Cigna of CA HMO |
$1,976.96
|
| Rate for Payer: Cigna of CA PPO |
$2,285.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,625.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,625.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,625.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,162.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,235.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,235.60
|
| Rate for Payer: Galaxy Health WC |
$2,625.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,853.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,780.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,961.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,121.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,822.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,162.30
|
| Rate for Payer: Multiplan Commercial |
$2,316.75
|
| Rate for Payer: Networks By Design Commercial |
$2,007.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,625.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,235.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,853.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,853.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,544.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,544.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,544.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,544.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,625.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,625.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,625.65
|
|
|
HC BONE/STEM HARVEST ALLOGENIC
|
Facility
|
IP
|
$5,380.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
911800301
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,076.00 |
| Max. Negotiated Rate |
$4,842.00 |
| Rate for Payer: Adventist Health Commercial |
$1,076.00
|
| Rate for Payer: Cash Price |
$2,421.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,304.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,766.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,152.00
|
| Rate for Payer: Galaxy Health WC |
$4,573.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,842.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,416.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,174.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.00
|
| Rate for Payer: Multiplan Commercial |
$4,035.00
|
| Rate for Payer: Networks By Design Commercial |
$3,497.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,573.00
|
|
|
HC BONE/STEM HARVEST ALLOGENIC
|
Facility
|
OP
|
$5,380.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
911800301
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$116.55 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,076.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$458.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,573.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,959.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,035.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,410.92
|
| Rate for Payer: Blue Shield of California EPN |
$2,146.62
|
| Rate for Payer: Cash Price |
$2,421.00
|
| Rate for Payer: Cash Price |
$2,421.00
|
| Rate for Payer: Cash Price |
$2,421.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,304.00
|
| Rate for Payer: Cigna of CA HMO |
$3,443.20
|
| Rate for Payer: Cigna of CA PPO |
$3,981.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,573.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,573.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,573.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,766.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,152.00
|
| Rate for Payer: Galaxy Health WC |
$4,573.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,842.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,416.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,174.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,766.00
|
| Rate for Payer: Multiplan Commercial |
$4,035.00
|
| Rate for Payer: Networks By Design Commercial |
$3,497.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,573.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,152.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,228.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,228.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,573.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,573.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,573.00
|
|
|
HC BONE/STEM HARVEST AUTOLOGUS
|
Facility
|
IP
|
$8,849.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
911800302
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,769.80 |
| Max. Negotiated Rate |
$7,964.10 |
| Rate for Payer: Adventist Health Commercial |
$1,769.80
|
| Rate for Payer: Cash Price |
$3,982.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,079.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,194.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,539.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,539.60
|
| Rate for Payer: Galaxy Health WC |
$7,521.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,309.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,964.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,619.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,220.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,769.80
|
| Rate for Payer: Multiplan Commercial |
$6,636.75
|
| Rate for Payer: Networks By Design Commercial |
$5,751.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,521.65
|
|
|
HC BONE/STEM HARVEST AUTOLOGUS
|
Facility
|
OP
|
$8,849.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
911800302
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$118.47 |
| Max. Negotiated Rate |
$7,964.10 |
| Rate for Payer: Adventist Health Commercial |
$1,769.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,003.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$462.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,318.68
|
| Rate for Payer: Blue Shield of California Commercial |
$5,610.27
|
| Rate for Payer: Blue Shield of California EPN |
$3,530.75
|
| Rate for Payer: Cash Price |
$3,982.05
|
| Rate for Payer: Cash Price |
$3,982.05
|
| Rate for Payer: Cash Price |
$3,982.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,079.20
|
| Rate for Payer: Cigna of CA HMO |
$5,663.36
|
| Rate for Payer: Cigna of CA PPO |
$6,548.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,003.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,003.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,194.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,305.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,203.42
|
| Rate for Payer: Galaxy Health WC |
$7,521.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,309.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,964.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,619.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,804.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,769.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,684.17
|
| Rate for Payer: Multiplan Commercial |
$6,636.75
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$5,751.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Preferred Health Network WC |
$3,386.41
|
| Rate for Payer: Prime Health Services Commercial |
$7,521.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,123.30
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Riverside University Health System MISP |
$2,203.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,309.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,309.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,003.11
|
|
|
HC BONE/STEM TRANS ALLOGENIC
|
Facility
|
IP
|
$12,885.00
|
|
|
Service Code
|
CPT 38240
|
| Hospital Charge Code |
907702201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$2,577.00 |
| Max. Negotiated Rate |
$11,596.50 |
| Rate for Payer: Adventist Health Commercial |
$2,577.00
|
| Rate for Payer: Cash Price |
$5,798.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,308.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,019.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,154.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,154.00
|
| Rate for Payer: Galaxy Health WC |
$10,952.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,731.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,596.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,181.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,602.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,577.00
|
| Rate for Payer: Multiplan Commercial |
$9,663.75
|
| Rate for Payer: Networks By Design Commercial |
$8,375.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,952.25
|
|
|
HC BONE/STEM TRANS ALLOGENIC
|
Facility
|
OP
|
$12,885.00
|
|
|
Service Code
|
CPT 38240
|
| Hospital Charge Code |
907702201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$179.29 |
| Max. Negotiated Rate |
$133,487.23 |
| Rate for Payer: Adventist Health Commercial |
$2,577.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$80,901.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$720.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121,352.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80,901.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80,901.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$119,732.14
|
| Rate for Payer: Blue Shield of California Commercial |
$8,169.09
|
| Rate for Payer: Blue Shield of California EPN |
$5,141.11
|
| Rate for Payer: CareMore Health Medicare Advantage |
$80,901.35
|
| Rate for Payer: Cash Price |
$5,798.25
|
| Rate for Payer: Cash Price |
$5,798.25
|
| Rate for Payer: Cash Price |
$5,798.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,308.00
|
| Rate for Payer: Cigna of CA HMO |
$8,246.40
|
| Rate for Payer: Cigna of CA PPO |
$9,534.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121,352.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$80,901.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80,901.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,019.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$133,487.23
|
| Rate for Payer: EPIC Health Plan Senior |
$88,991.49
|
| Rate for Payer: Galaxy Health WC |
$10,952.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,731.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,596.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$132,678.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$179.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80,901.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,181.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113,261.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,577.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$108,407.81
|
| Rate for Payer: Multiplan Commercial |
$9,663.75
|
| Rate for Payer: Multiplan WC |
$119,732.14
|
| Rate for Payer: Networks By Design Commercial |
$8,375.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$80,901.35
|
| Rate for Payer: Preferred Health Network WC |
$122,175.65
|
| Rate for Payer: Prime Health Services Commercial |
$10,952.25
|
| Rate for Payer: Prime Health Services Medicare |
$85,755.43
|
| Rate for Payer: Prime Health Services WC |
$118,510.38
|
| Rate for Payer: Riverside University Health System MISP |
$88,991.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,731.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,731.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$80,901.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121,352.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80,901.35
|
| Rate for Payer: Vantage Medical Group Senior |
$80,901.35
|
|
|
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 |
$4,984.20 |
| Rate for Payer: Adventist Health Commercial |
$1,107.60
|
| Rate for Payer: Cash Price |
$2,492.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,430.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,876.60
|
| 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: Health Management Network EPO/PPO |
$4,984.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,516.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,267.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,107.60
|
| Rate for Payer: Multiplan Commercial |
$4,153.50
|
| Rate for Payer: Networks By Design Commercial |
$3,599.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,707.30
|
|
|
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 |
$137.03 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,107.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,003.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$550.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,003.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,318.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3,511.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,209.66
|
| Rate for Payer: CareMore Health Medicare Advantage |
$2,003.11
|
| 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: Central Health Plan Commercial |
$4,430.40
|
| 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 |
$3,004.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,003.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,003.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,876.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,305.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,203.42
|
| Rate for Payer: Galaxy Health WC |
$4,707.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,322.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,984.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$137.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,516.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,804.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,107.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,684.17
|
| Rate for Payer: Multiplan Commercial |
$4,153.50
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$3,599.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Preferred Health Network WC |
$3,386.41
|
| Rate for Payer: Prime Health Services Commercial |
$4,707.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,123.30
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Riverside University Health System MISP |
$2,203.42
|
| 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: Upland Medical Group Pediatric |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,003.11
|
|
|
HC BONE/STEM TRANS AUTOLOGUS
|
Facility
|
IP
|
$11,893.00
|
|
|
Service Code
|
CPT 38241
|
| Hospital Charge Code |
907702202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$2,378.60 |
| Max. Negotiated Rate |
$10,703.70 |
| Rate for Payer: Adventist Health Commercial |
$2,378.60
|
| Rate for Payer: Cash Price |
$5,351.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,514.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,325.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,757.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,757.20
|
| Rate for Payer: Galaxy Health WC |
$10,109.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,135.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,703.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,552.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,016.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,378.60
|
| Rate for Payer: Multiplan Commercial |
$8,919.75
|
| Rate for Payer: Networks By Design Commercial |
$7,730.45
|
| Rate for Payer: Prime Health Services Commercial |
$10,109.05
|
|
|
HC BONE/STEM TRANS AUTOLOGUS
|
Facility
|
OP
|
$11,893.00
|
|
|
Service Code
|
CPT 38241
|
| Hospital Charge Code |
907702202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$179.29 |
| Max. Negotiated Rate |
$130,000.00 |
| Rate for Payer: Adventist Health Commercial |
$2,378.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,003.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$719.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,003.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,318.68
|
| Rate for Payer: Blue Shield of California Commercial |
$7,540.16
|
| Rate for Payer: Blue Shield of California EPN |
$4,745.31
|
| Rate for Payer: CareMore Health Medicare Advantage |
$2,003.11
|
| Rate for Payer: Cash Price |
$5,351.85
|
| Rate for Payer: Cash Price |
$5,351.85
|
| Rate for Payer: Cash Price |
$5,351.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,514.40
|
| Rate for Payer: Cigna of CA HMO |
$7,611.52
|
| Rate for Payer: Cigna of CA PPO |
$8,800.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,003.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,003.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,305.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,203.42
|
| Rate for Payer: Galaxy Health WC |
$10,109.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,135.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,703.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$179.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,552.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,804.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,378.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,684.17
|
| Rate for Payer: Multiplan Commercial |
$8,919.75
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$7,730.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Preferred Health Network WC |
$3,386.41
|
| Rate for Payer: Prime Health Services Commercial |
$10,109.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,123.30
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Riverside University Health System MISP |
$2,203.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,135.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,135.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,003.11
|
|
|
HC BONE SURVEY COMPLETE
|
Facility
|
OP
|
$3,023.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,720.70 |
| Rate for Payer: Adventist Health Commercial |
$604.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$481.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$300.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$417.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,904.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,200.13
|
| Rate for Payer: Cash Price |
$1,360.35
|
| Rate for Payer: Cash Price |
$1,360.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,418.40
|
| Rate for Payer: Cigna of CA HMO |
$1,934.72
|
| Rate for Payer: Cigna of CA PPO |
$2,237.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,116.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$2,569.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,813.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,720.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,919.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$2,267.25
|
| Rate for Payer: Networks By Design Commercial |
$1,964.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$2,569.55
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,813.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,813.80
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC BONE SURVEY COMPLETE
|
Facility
|
IP
|
$3,023.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$604.60 |
| Max. Negotiated Rate |
$2,720.70 |
| Rate for Payer: Adventist Health Commercial |
$604.60
|
| Rate for Payer: Cash Price |
$1,360.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,418.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,116.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,209.20
|
| Rate for Payer: Galaxy Health WC |
$2,569.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,813.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,720.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,919.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,783.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.60
|
| Rate for Payer: Multiplan Commercial |
$2,267.25
|
| Rate for Payer: Networks By Design Commercial |
$1,964.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,569.55
|
|
|
HC BONE SURVEY INFANT
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$422.81 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$422.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$154.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.55
|
| Rate for Payer: Blue Shield of California Commercial |
$284.76
|
| Rate for Payer: Blue Shield of California EPN |
$179.44
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Cigna of CA HMO |
$289.28
|
| Rate for Payer: Cigna of CA PPO |
$334.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$287.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC BONE SURVEY INFANT
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$287.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$266.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
|
|
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 |
$29.66 |
| Rate for Payer: Adventist Health Commercial |
$6.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.02
|
| 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 Exchange |
$15.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.17
|
| Rate for Payer: Blue Shield of California Commercial |
$20.90
|
| Rate for Payer: Blue Shield of California EPN |
$13.15
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Central Health Plan Commercial |
$26.37
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.07
|
| 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: Health Management Network EPO/PPO |
$29.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.07
|
| Rate for Payer: Multiplan Commercial |
$24.72
|
| Rate for Payer: Networks By Design Commercial |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$28.02
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| 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 |
$29.66 |
| Rate for Payer: Adventist Health Commercial |
$6.59
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Central Health Plan Commercial |
$26.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.07
|
| 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: Health Management Network EPO/PPO |
$29.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.59
|
| Rate for Payer: Multiplan Commercial |
$24.72
|
| Rate for Payer: Networks By Design Commercial |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$28.02
|
|
|
HC BOOT CAST PEDS LG
|
Facility
|
IP
|
$114.99
|
|
| Hospital Charge Code |
901692802
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.49 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$91.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.49
|
| 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: Health Management Network EPO/PPO |
$103.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$86.24
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
|
|
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 |
$103.49 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.83
|
| 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 Exchange |
$55.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.89
|
| Rate for Payer: Blue Shield of California Commercial |
$72.90
|
| Rate for Payer: Blue Shield of California EPN |
$45.88
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$91.99
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.49
|
| 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: Health Management Network EPO/PPO |
$103.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.49
|
| Rate for Payer: Multiplan Commercial |
$86.24
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
| Rate for Payer: Riverside University Health System MISP |
$46.00
|
| 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
|
|
