|
HC BONE AGE
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
909001602
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.37 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.50
|
| Rate for Payer: Blue Distinction Transplant |
$449.40
|
| Rate for Payer: Blue Shield of California Commercial |
$462.88
|
| Rate for Payer: Blue Shield of California EPN |
$364.01
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Central Health Plan Commercial |
$599.20
|
| Rate for Payer: Cigna of CA HMO |
$479.36
|
| Rate for Payer: Cigna of CA PPO |
$554.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$636.65
|
| Rate for Payer: Global Benefits Group Commercial |
$449.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$674.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$561.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$499.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: Networks By Design Commercial |
$486.85
|
| Rate for Payer: Prime Health Services Commercial |
$636.65
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$449.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$449.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC BONE AGE
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
909001602
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Central Health Plan Commercial |
$599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.60
|
| Rate for Payer: Galaxy Health WC |
$636.65
|
| Rate for Payer: Global Benefits Group Commercial |
$449.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$674.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$499.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.80
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: Networks By Design Commercial |
$486.85
|
| Rate for Payer: Prime Health Services Commercial |
$636.65
|
|
|
HC BONE BIOPSY DEEP, PERCUTAN
|
Facility
|
IP
|
$5,959.00
|
|
|
Service Code
|
CPT 20225
|
| Hospital Charge Code |
909000107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,191.80 |
| Max. Negotiated Rate |
$5,363.10 |
| Rate for Payer: Cash Price |
$2,681.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,767.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,383.60
|
| Rate for Payer: Galaxy Health WC |
$5,065.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,363.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,974.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,270.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.80
|
| Rate for Payer: Multiplan Commercial |
$4,469.25
|
| Rate for Payer: Networks By Design Commercial |
$3,873.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,065.15
|
|
|
HC BONE BIOPSY DEEP, PERCUTAN
|
Facility
|
OP
|
$5,959.00
|
|
|
Service Code
|
CPT 20225
|
| Hospital Charge Code |
909000107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,575.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,681.55
|
| Rate for Payer: Cash Price |
$2,681.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,767.20
|
| Rate for Payer: Cigna of CA PPO |
$4,409.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$5,065.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,363.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,469.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,974.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$4,469.25
|
| Rate for Payer: Networks By Design Commercial |
$3,873.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,065.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,575.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BONE BIOPSY SUPFCL, PERCUT
|
Facility
|
OP
|
$2,755.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
909000106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,653.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$1,239.75
|
| Rate for Payer: Cash Price |
$1,239.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,204.00
|
| Rate for Payer: Cigna of CA PPO |
$2,038.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$2,341.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,653.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,479.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,066.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,837.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$2,066.25
|
| Rate for Payer: Networks By Design Commercial |
$1,790.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,341.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,653.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BONE BIOPSY SUPFCL, PERCUT
|
Facility
|
IP
|
$2,755.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
909000106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$551.00 |
| Max. Negotiated Rate |
$2,479.50 |
| Rate for Payer: Cash Price |
$1,239.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,102.00
|
| Rate for Payer: Galaxy Health WC |
$2,341.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,653.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,479.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,837.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,049.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.00
|
| Rate for Payer: Multiplan Commercial |
$2,066.25
|
| Rate for Payer: Networks By Design Commercial |
$1,790.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,341.75
|
|
|
HC BONE CEMENT
|
Facility
|
IP
|
$805.00
|
|
| Hospital Charge Code |
909081735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Blue Shield of California EPN |
$429.87
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Central Health Plan Commercial |
$644.00
|
| Rate for Payer: Cigna of CA HMO |
$563.50
|
| Rate for Payer: Cigna of CA PPO |
$563.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$724.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.97
|
| Rate for Payer: United Healthcare All Other HMO |
$296.88
|
| Rate for Payer: United Healthcare HMO Rider |
$290.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$265.65
|
|
|
HC BONE CEMENT
|
Facility
|
OP
|
$805.00
|
|
| Hospital Charge Code |
909081735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$442.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$367.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$448.38
|
| Rate for Payer: Blue Distinction Transplant |
$483.00
|
| Rate for Payer: Blue Shield of California Commercial |
$603.75
|
| Rate for Payer: Blue Shield of California EPN |
$437.92
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Central Health Plan Commercial |
$644.00
|
| Rate for Payer: Cigna of CA HMO |
$563.50
|
| Rate for Payer: Cigna of CA PPO |
$563.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Media |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$724.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$603.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$281.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: Networks By Design Commercial |
$402.50
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: Riverside University Health System MISP |
$322.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$402.50
|
| Rate for Payer: United Healthcare All Other HMO |
$402.50
|
| Rate for Payer: United Healthcare HMO Rider |
$402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$402.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC BONE, FINE NEEDLE ASPIRATION
|
Facility
|
IP
|
$1,481.00
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
909020019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$296.20 |
| Max. Negotiated Rate |
$1,332.90 |
| Rate for Payer: Cash Price |
$666.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.40
|
| Rate for Payer: Galaxy Health WC |
$1,258.85
|
| Rate for Payer: Global Benefits Group Commercial |
$888.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,332.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$564.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.20
|
| Rate for Payer: Multiplan Commercial |
$1,110.75
|
| Rate for Payer: Networks By Design Commercial |
$962.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.85
|
|
|
HC BONE, FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$1,481.00
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
909020019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$296.20 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$888.60
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$666.45
|
| Rate for Payer: Cash Price |
$666.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,184.80
|
| Rate for Payer: Cigna of CA PPO |
$1,095.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,258.85
|
| Rate for Payer: Global Benefits Group Commercial |
$888.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,332.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,110.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,110.75
|
| Rate for Payer: Networks By Design Commercial |
$962.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.85
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$888.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BONE LENGTH
|
Facility
|
IP
|
$1,241.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
909001603
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$248.20 |
| Max. Negotiated Rate |
$1,116.90 |
| Rate for Payer: Cash Price |
$558.45
|
| Rate for Payer: Central Health Plan Commercial |
$992.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.40
|
| Rate for Payer: Galaxy Health WC |
$1,054.85
|
| Rate for Payer: Global Benefits Group Commercial |
$744.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,116.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$827.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$472.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.20
|
| Rate for Payer: Multiplan Commercial |
$930.75
|
| Rate for Payer: Networks By Design Commercial |
$806.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,054.85
|
|
|
HC BONE LENGTH
|
Facility
|
OP
|
$1,241.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
909001603
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.90 |
| Max. Negotiated Rate |
$1,116.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.55
|
| Rate for Payer: Blue Distinction Transplant |
$744.60
|
| Rate for Payer: Blue Shield of California Commercial |
$766.94
|
| Rate for Payer: Blue Shield of California EPN |
$603.13
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$558.45
|
| Rate for Payer: Cash Price |
$558.45
|
| Rate for Payer: Central Health Plan Commercial |
$992.80
|
| Rate for Payer: Cigna of CA HMO |
$794.24
|
| Rate for Payer: Cigna of CA PPO |
$918.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,054.85
|
| Rate for Payer: Global Benefits Group Commercial |
$744.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,116.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$930.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$827.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$930.75
|
| Rate for Payer: Networks By Design Commercial |
$806.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,054.85
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$744.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$744.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC BONE MARROW ASP/AT TIME OF BX
|
Facility
|
IP
|
$3,671.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
911800314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$734.20 |
| Max. Negotiated Rate |
$3,303.90 |
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,936.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.40
|
| Rate for Payer: Galaxy Health WC |
$3,120.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,202.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,303.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,448.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,398.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.20
|
| Rate for Payer: Multiplan Commercial |
$2,753.25
|
| Rate for Payer: Networks By Design Commercial |
$2,386.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,120.35
|
|
|
HC BONE MARROW ASP/AT TIME OF BX
|
Facility
|
OP
|
$3,671.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
911800314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.98 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,550.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,202.60
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$3,550.26
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,936.80
|
| Rate for Payer: Cigna of CA PPO |
$2,716.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Galaxy Health WC |
$3,120.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,202.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,303.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,753.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,822.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,857.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: InnovAge PACE Commercial |
$5,325.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,448.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,757.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Multiplan Commercial |
$2,753.25
|
| Rate for Payer: Networks By Design Commercial |
$2,386.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,120.35
|
| Rate for Payer: Prime Health Services Medicare |
$3,763.28
|
| Rate for Payer: Riverside University Health System MISP |
$3,905.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,202.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC BONE MARROW ASP ONLY
|
Facility
|
OP
|
$2,279.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
911800312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.73 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,367.40
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,823.20
|
| Rate for Payer: Cigna of CA PPO |
$1,686.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$1,937.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,367.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,051.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,709.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,520.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$1,709.25
|
| Rate for Payer: Networks By Design Commercial |
$1,481.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,937.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,367.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BONE MARROW ASP ONLY
|
Facility
|
IP
|
$2,279.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
911800312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$455.80 |
| Max. Negotiated Rate |
$2,051.10 |
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,823.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.60
|
| Rate for Payer: Galaxy Health WC |
$1,937.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,367.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,051.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,520.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$868.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.80
|
| Rate for Payer: Multiplan Commercial |
$1,709.25
|
| Rate for Payer: Networks By Design Commercial |
$1,481.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,937.15
|
|
|
HC BONE MARROW BX ONLY
|
Facility
|
OP
|
$3,671.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
909020057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$372.08 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,202.60
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,936.80
|
| Rate for Payer: Cigna of CA PPO |
$2,716.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$3,120.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,202.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,303.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,753.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,448.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$2,753.25
|
| Rate for Payer: Networks By Design Commercial |
$2,386.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,120.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,202.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BONE MARROW BX ONLY
|
Facility
|
IP
|
$3,671.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
909020057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$734.20 |
| Max. Negotiated Rate |
$3,303.90 |
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,936.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.40
|
| Rate for Payer: Galaxy Health WC |
$3,120.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,202.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,303.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,448.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,398.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.20
|
| Rate for Payer: Multiplan Commercial |
$2,753.25
|
| Rate for Payer: Networks By Design Commercial |
$2,386.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,120.35
|
|
|
HC BONE MARROW IMAGING, LTD
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
909301330
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$177.18 |
| Max. Negotiated Rate |
$1,445.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$782.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$948.82
|
| Rate for Payer: Blue Distinction Transplant |
$963.60
|
| Rate for Payer: Blue Shield of California Commercial |
$992.51
|
| Rate for Payer: Blue Shield of California EPN |
$780.52
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,284.80
|
| Rate for Payer: Cigna of CA HMO |
$1,027.84
|
| Rate for Payer: Cigna of CA PPO |
$1,188.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,445.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,204.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$850.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: InnovAge PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,204.50
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Riverside University Health System MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$963.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$963.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC BONE MARROW IMAGING, LTD
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
909301330
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$1,445.40 |
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,284.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,445.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$611.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.20
|
| Rate for Payer: Multiplan Commercial |
$1,204.50
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
|
|
HC BONE SCAN LIMITED
|
Facility
|
IP
|
$2,040.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
909301370
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,632.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$816.00
|
| Rate for Payer: Galaxy Health WC |
$1,734.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,224.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,836.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,360.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$777.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.00
|
| Rate for Payer: Multiplan Commercial |
$1,530.00
|
| Rate for Payer: Networks By Design Commercial |
$1,326.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,734.00
|
|
|
HC BONE SCAN LIMITED
|
Facility
|
OP
|
$2,040.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
909301370
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$153.73 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$814.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$506.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,205.23
|
| Rate for Payer: Blue Distinction Transplant |
$1,224.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,260.72
|
| Rate for Payer: Blue Shield of California EPN |
$991.44
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,632.00
|
| Rate for Payer: Cigna of CA HMO |
$1,305.60
|
| Rate for Payer: Cigna of CA PPO |
$1,509.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,734.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,224.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,836.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,530.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$850.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: InnovAge PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,360.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,530.00
|
| Rate for Payer: Networks By Design Commercial |
$1,326.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,734.00
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Riverside University Health System MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,224.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,224.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.16
|
| Rate for Payer: United Healthcare All Other HMO |
$632.16
|
| Rate for Payer: United Healthcare HMO Rider |
$632.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC BONE SCAN WHOLE BODY
|
Facility
|
OP
|
$3,597.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
909301371
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$267.96 |
| Max. Negotiated Rate |
$3,237.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,183.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$867.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,125.11
|
| Rate for Payer: Blue Distinction Transplant |
$2,158.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,222.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,748.14
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,877.60
|
| Rate for Payer: Cigna of CA HMO |
$2,302.08
|
| Rate for Payer: Cigna of CA PPO |
$2,661.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$3,057.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,158.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,237.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,697.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$850.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: InnovAge PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,399.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$2,697.75
|
| Rate for Payer: Networks By Design Commercial |
$2,338.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,057.45
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Riverside University Health System MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,158.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,158.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC BONE SCAN WHOLE BODY
|
Facility
|
IP
|
$3,597.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
909301371
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$719.40 |
| Max. Negotiated Rate |
$3,237.30 |
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,877.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,438.80
|
| Rate for Payer: Galaxy Health WC |
$3,057.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,158.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,237.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,399.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,370.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.40
|
| Rate for Payer: Multiplan Commercial |
$2,697.75
|
| Rate for Payer: Networks By Design Commercial |
$2,338.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,057.45
|
|
|
HC BONE/STEM HARVEST ALLOGENIC
|
Facility
|
OP
|
$4,924.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
911800301
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$128.74 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$434.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,185.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,708.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,708.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,954.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,097.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,407.84
|
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,939.20
|
| Rate for Payer: Cigna of CA HMO |
$3,151.36
|
| Rate for Payer: Cigna of CA PPO |
$3,643.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,185.40
|
| Rate for Payer: Dignity Health Media |
$4,185.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,185.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,969.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,969.60
|
| Rate for Payer: Galaxy Health WC |
$4,185.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,954.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,431.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,693.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,723.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,284.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$984.80
|
| Rate for Payer: Multiplan Commercial |
$3,693.00
|
| Rate for Payer: Networks By Design Commercial |
$3,200.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,185.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,969.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,954.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,954.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,462.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,462.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,462.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,462.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,185.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,185.40
|
|
