|
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 |
$1,698.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,471.20
|
| 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 Permanente of CA Commercial/Self Funded |
$2,060.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,176.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,912.09
|
| 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/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 |
$2,959.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,304.00
|
| 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 Permanente of CA Commercial/Self Funded |
$3,588.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,049.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,330.22
|
| 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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,076.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,267.27
|
| 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 |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,287.18
|
| Rate for Payer: Blue Shield of California EPN |
$2,146.62
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Cash Price |
$2,959.00
|
| 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: 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: InnovAge PACE Commercial |
$2,690.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,588.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,330.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,766.00
|
| Rate for Payer: Molina Healthcare of CA 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: United Healthcare All Other Commercial |
$2,690.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,690.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,690.00
|
| 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
|
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 |
$2,082.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,374.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,291.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,082.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,318.68
|
| Rate for Payer: Blue Shield of California Commercial |
$5,406.74
|
| Rate for Payer: Blue Shield of California EPN |
$3,530.75
|
| Rate for Payer: Cash Price |
$4,866.95
|
| Rate for Payer: Cash Price |
$4,866.95
|
| Rate for Payer: Cash Price |
$4,866.95
|
| 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 |
$3,124.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,082.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,811.87
|
| Rate for Payer: EPIC Health Plan Senior |
$2,082.87
|
| Rate for Payer: Galaxy Health WC |
$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 |
$3,415.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,082.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,124.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,902.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,769.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,791.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.05
|
| 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 |
$2,082.87
|
| 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 |
$2,207.84
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Riverside University Health System MISP |
$2,291.16
|
| 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: United Healthcare All Other Commercial |
$4,424.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,424.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,424.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,424.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.87
|
|
|
HC BONE/STEM 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 |
$4,866.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,079.20
|
| 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 Permanente of CA Commercial/Self Funded |
$5,902.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,371.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,477.53
|
| 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 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 |
$123,239.83 |
| Rate for Payer: Adventist Health Commercial |
$2,577.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$75,146.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112,719.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75,146.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75,146.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$119,732.14
|
| Rate for Payer: Blue Shield of California Commercial |
$7,872.73
|
| Rate for Payer: Blue Shield of California EPN |
$5,141.11
|
| Rate for Payer: Caremore Medicare Advantage |
$75,146.24
|
| Rate for Payer: Cash Price |
$7,086.75
|
| Rate for Payer: Cash Price |
$7,086.75
|
| Rate for Payer: Cash Price |
$7,086.75
|
| 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 |
$112,719.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$75,146.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75,146.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$101,447.42
|
| Rate for Payer: EPIC Health Plan Senior |
$75,146.24
|
| Rate for Payer: Galaxy Health WC |
$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 |
$123,239.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$179.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75,146.24
|
| Rate for Payer: InnovAge PACE Commercial |
$112,719.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,594.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75,146.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,577.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100,695.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100,695.96
|
| 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 |
$75,146.24
|
| 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 |
$79,655.01
|
| Rate for Payer: Prime Health Services WC |
$118,510.38
|
| Rate for Payer: Riverside University Health System MISP |
$82,660.86
|
| 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: United Healthcare All Other Commercial |
$6,442.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,442.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,442.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,442.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$75,146.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112,719.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75,146.24
|
| Rate for Payer: Vantage Medical Group Senior |
$75,146.24
|
|
|
HC BONE/STEM TRANS ALLOGENIC
|
Facility
|
IP
|
$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 |
$7,086.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,308.00
|
| 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 Permanente of CA Commercial/Self Funded |
$8,594.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,909.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,975.81
|
| 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 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 |
$3,045.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,430.40
|
| 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 Permanente of CA Commercial/Self Funded |
$3,693.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,109.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,428.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,107.60
|
| 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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,107.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,082.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,363.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,082.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,082.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,318.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3,383.72
|
| Rate for Payer: Blue Shield of California EPN |
$2,209.66
|
| Rate for Payer: Caremore Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$3,045.90
|
| Rate for Payer: Cash Price |
$3,045.90
|
| Rate for Payer: Cash Price |
$3,045.90
|
| 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 |
$3,124.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,082.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,811.87
|
| Rate for Payer: EPIC Health Plan Senior |
$2,082.87
|
| Rate for Payer: Galaxy Health WC |
$4,707.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,322.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,984.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,415.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$137.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,082.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,124.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,693.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,107.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,791.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.05
|
| 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 |
$2,082.87
|
| 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 |
$2,207.84
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Riverside University Health System MISP |
$2,291.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,322.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,322.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,769.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,769.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,769.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,769.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.87
|
|
|
HC BONE/STEM TRANS 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 |
$6,541.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,514.40
|
| 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 Permanente of CA Commercial/Self Funded |
$7,932.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,531.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,361.77
|
| 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 |
$11,071.00 |
| Rate for Payer: Adventist Health Commercial |
$2,378.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,082.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,082.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,082.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,318.68
|
| Rate for Payer: Blue Shield of California Commercial |
$7,266.62
|
| Rate for Payer: Blue Shield of California EPN |
$4,745.31
|
| Rate for Payer: Caremore Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$6,541.15
|
| Rate for Payer: Cash Price |
$6,541.15
|
| Rate for Payer: Cash Price |
$6,541.15
|
| 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 |
$3,124.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,082.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,811.87
|
| Rate for Payer: EPIC Health Plan Senior |
$2,082.87
|
| Rate for Payer: Galaxy Health WC |
$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 |
$3,415.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$179.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,082.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,124.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,932.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,378.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,791.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.05
|
| 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 |
$2,082.87
|
| 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 |
$2,207.84
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Riverside University Health System MISP |
$2,291.16
|
| 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: United Healthcare All Other Commercial |
$5,946.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,946.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,946.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,946.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.87
|
|
|
HC BONE 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 |
$1,662.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,418.40
|
| 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 Permanente of CA Commercial/Self Funded |
$2,016.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,151.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,871.24
|
| 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 COMPLETE
|
Facility
|
OP
|
$3,023.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.95 |
| Max. Negotiated Rate |
$2,720.70 |
| Rate for Payer: Adventist Health Commercial |
$604.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,835.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$300.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,834.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,200.13
|
| Rate for Payer: Cash Price |
$1,662.65
|
| Rate for Payer: Cash Price |
$1,662.65
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,016.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,569.55
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC BONE SURVEY INFANT
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$274.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$154.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.32
|
| Rate for Payer: Blue Shield of California Commercial |
$274.36
|
| Rate for Payer: Blue Shield of California EPN |
$179.44
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Cash Price |
$248.60
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC BONE SURVEY INFANT
|
Facility
|
IP
|
$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 |
$248.60
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| 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 Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$279.79
|
| 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 |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$20.14
|
| Rate for Payer: Blue Shield of California EPN |
$13.15
|
| Rate for Payer: Cash Price |
$18.13
|
| 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: 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: InnovAge PACE Commercial |
$16.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.07
|
| Rate for Payer: Multiplan Commercial |
$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 |
$18.13
|
| Rate for Payer: Central Health Plan Commercial |
$26.37
|
| 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 Permanente of CA Commercial/Self Funded |
$21.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
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 |
$67.53
|
| Rate for Payer: Blue Shield of California Commercial |
$70.26
|
| Rate for Payer: Blue Shield of California EPN |
$45.88
|
| Rate for Payer: Cash Price |
$63.24
|
| 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: 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: InnovAge PACE Commercial |
$57.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.49
|
| Rate for Payer: Multiplan Commercial |
$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
|
|
|
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 |
$63.24
|
| Rate for Payer: Central Health Plan Commercial |
$91.99
|
| 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 Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 MED
|
Facility
|
IP
|
$114.99
|
|
| Hospital Charge Code |
901692801
|
|
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 |
$63.24
|
| Rate for Payer: Central Health Plan Commercial |
$91.99
|
| 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 Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 MED
|
Facility
|
OP
|
$114.99
|
|
| Hospital Charge Code |
901692801
|
|
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 |
$67.53
|
| Rate for Payer: Blue Shield of California Commercial |
$70.26
|
| Rate for Payer: Blue Shield of California EPN |
$45.88
|
| Rate for Payer: Cash Price |
$63.24
|
| 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: 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: InnovAge PACE Commercial |
$57.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.49
|
| Rate for Payer: Multiplan Commercial |
$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
|
|
|
HC BOOT CAST PEDS SM
|
Facility
|
OP
|
$114.99
|
|
| Hospital Charge Code |
901692800
|
|
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 |
$67.53
|
| Rate for Payer: Blue Shield of California Commercial |
$70.26
|
| Rate for Payer: Blue Shield of California EPN |
$45.88
|
| Rate for Payer: Cash Price |
$63.24
|
| 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: 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: InnovAge PACE Commercial |
$57.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.49
|
| Rate for Payer: Multiplan Commercial |
$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
|
|
|
HC BOOT CAST PEDS SM
|
Facility
|
IP
|
$114.99
|
|
| Hospital Charge Code |
901692800
|
|
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 |
$63.24
|
| Rate for Payer: Central Health Plan Commercial |
$91.99
|
| 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 Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 STNDRD
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901692803
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC BOOT CAST PEDS STNDRD
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901692803
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
