|
HC BONE/STEM HARVEST ALLOGENIC
|
Facility
|
IP
|
$4,924.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
911800301
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$984.80 |
| Max. Negotiated Rate |
$4,431.60 |
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,939.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$3,284.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,876.04
|
| 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
|
|
|
HC BONE/STEM HARVEST AUTOLOGUS
|
Facility
|
OP
|
$6,691.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
911800302
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$130.87 |
| Max. Negotiated Rate |
$6,021.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,917.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$437.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| 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 |
$4,014.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,208.64
|
| Rate for Payer: Blue Shield of California EPN |
$3,271.90
|
| Rate for Payer: Caremore Medicare Advantage |
$1,917.03
|
| Rate for Payer: Cash Price |
$3,010.95
|
| Rate for Payer: Cash Price |
$3,010.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,352.80
|
| Rate for Payer: Cigna of CA HMO |
$4,282.24
|
| Rate for Payer: Cigna of CA PPO |
$4,951.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$5,687.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,014.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,021.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,018.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,163.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: InnovAge PACE Commercial |
$2,875.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,568.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$5,018.25
|
| Rate for Payer: Networks By Design Commercial |
$4,349.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,687.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,032.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,108.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,014.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,014.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,345.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,345.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,345.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,345.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,917.03
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC BONE/STEM HARVEST AUTOLOGUS
|
Facility
|
IP
|
$6,691.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
911800302
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,338.20 |
| Max. Negotiated Rate |
$6,021.90 |
| Rate for Payer: Cash Price |
$3,010.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,352.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,676.40
|
| Rate for Payer: Galaxy Health WC |
$5,687.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,014.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,021.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,549.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.20
|
| Rate for Payer: Multiplan Commercial |
$5,018.25
|
| Rate for Payer: Networks By Design Commercial |
$4,349.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,687.35
|
|
|
HC BONE/STEM TRANS ALLOGENIC
|
Facility
|
OP
|
$9,743.00
|
|
|
Service Code
|
CPT 38240
|
| Hospital Charge Code |
907702201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$198.06 |
| Max. Negotiated Rate |
$112,656.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$68,276.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102,414.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75,104.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68,276.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$93,343.67
|
| Rate for Payer: Blue Distinction Transplant |
$5,845.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$4,764.33
|
| Rate for Payer: Caremore Medicare Advantage |
$68,276.45
|
| Rate for Payer: Cash Price |
$4,384.35
|
| Rate for Payer: Cash Price |
$4,384.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,794.40
|
| Rate for Payer: Cigna of CA HMO |
$6,235.52
|
| Rate for Payer: Cigna of CA PPO |
$7,209.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102,414.68
|
| Rate for Payer: Dignity Health Media |
$68,276.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$68,276.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$92,173.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$68,276.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$68,276.45
|
| Rate for Payer: Galaxy Health WC |
$8,281.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,845.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,768.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,307.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111,973.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$112,656.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68,276.45
|
| Rate for Payer: InnovAge PACE Commercial |
$102,414.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,498.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68,276.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,948.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91,490.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91,490.44
|
| Rate for Payer: Multiplan Commercial |
$7,307.25
|
| Rate for Payer: Multiplan WC |
$93,343.67
|
| Rate for Payer: Networks By Design Commercial |
$6,332.95
|
| Rate for Payer: Preferred Health Network WC |
$95,248.64
|
| Rate for Payer: Prime Health Services Commercial |
$8,281.55
|
| Rate for Payer: Prime Health Services Medicare |
$72,373.04
|
| Rate for Payer: Prime Health Services WC |
$92,391.18
|
| Rate for Payer: Riverside University Health System MISP |
$75,104.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,845.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,845.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,871.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,871.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,871.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,871.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102,414.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68,276.45
|
| Rate for Payer: Vantage Medical Group Senior |
$68,276.45
|
|
|
HC BONE/STEM TRANS ALLOGENIC
|
Facility
|
IP
|
$9,743.00
|
|
|
Service Code
|
CPT 38240
|
| Hospital Charge Code |
907702201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,948.60 |
| Max. Negotiated Rate |
$8,768.70 |
| Rate for Payer: Cash Price |
$4,384.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,794.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,897.20
|
| Rate for Payer: Galaxy Health WC |
$8,281.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,845.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,768.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,498.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,712.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,948.60
|
| Rate for Payer: Multiplan Commercial |
$7,307.25
|
| Rate for Payer: Networks By Design Commercial |
$6,332.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,281.55
|
|
|
HC BONE/STEM TRANS ALLOG LYMPH
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
CPT 38242
|
| Hospital Charge Code |
907702205
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$151.37 |
| Max. Negotiated Rate |
$5,098.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,917.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$520.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| 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 |
$3,399.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,563.28
|
| Rate for Payer: Blue Shield of California EPN |
$2,770.18
|
| Rate for Payer: Caremore Medicare Advantage |
$1,917.03
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,532.00
|
| Rate for Payer: Cigna of CA HMO |
$3,625.60
|
| Rate for Payer: Cigna of CA PPO |
$4,192.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,098.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,248.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,163.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: InnovAge PACE Commercial |
$2,875.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,778.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,568.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$4,248.75
|
| Rate for Payer: Networks By Design Commercial |
$3,682.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,032.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,108.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,399.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,399.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,832.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,832.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,832.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,832.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,917.03
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC BONE/STEM TRANS ALLOG LYMPH
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
CPT 38242
|
| Hospital Charge Code |
907702205
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,133.00 |
| Max. Negotiated Rate |
$5,098.50 |
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,532.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,266.00
|
| Rate for Payer: Galaxy Health WC |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,098.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,778.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,158.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.00
|
| Rate for Payer: Multiplan Commercial |
$4,248.75
|
| Rate for Payer: Networks By Design Commercial |
$3,682.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
|
|
HC BONE/STEM TRANS AUTOLOGUS
|
Facility
|
OP
|
$8,993.00
|
|
|
Service Code
|
CPT 38241
|
| Hospital Charge Code |
907702202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$198.06 |
| Max. Negotiated Rate |
$11,071.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,917.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,395.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,656.60
|
| Rate for Payer: Blue Shield of California EPN |
$4,397.58
|
| Rate for Payer: Caremore Medicare Advantage |
$1,917.03
|
| Rate for Payer: Cash Price |
$4,046.85
|
| Rate for Payer: Cash Price |
$4,046.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,194.40
|
| Rate for Payer: Cigna of CA HMO |
$5,755.52
|
| Rate for Payer: Cigna of CA PPO |
$6,654.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$7,644.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,395.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,093.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,744.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,163.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: InnovAge PACE Commercial |
$2,875.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,998.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,568.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$6,744.75
|
| Rate for Payer: Networks By Design Commercial |
$5,845.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,644.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,032.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,108.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,395.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,395.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,496.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,496.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,496.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,496.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,917.03
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC BONE/STEM TRANS AUTOLOGUS
|
Facility
|
IP
|
$8,993.00
|
|
|
Service Code
|
CPT 38241
|
| Hospital Charge Code |
907702202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,798.60 |
| Max. Negotiated Rate |
$8,093.70 |
| Rate for Payer: Cash Price |
$4,046.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,194.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,597.20
|
| Rate for Payer: Galaxy Health WC |
$7,644.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,395.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,093.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,998.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,426.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.60
|
| Rate for Payer: Multiplan Commercial |
$6,744.75
|
| Rate for Payer: Networks By Design Commercial |
$5,845.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,644.05
|
|
|
HC BONE SURVEY COMPLETE
|
Facility
|
OP
|
$2,723.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,450.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$425.02
|
| 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 |
$300.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.33
|
| Rate for Payer: Blue Distinction Transplant |
$1,633.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,682.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,323.38
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$1,225.35
|
| Rate for Payer: Cash Price |
$1,225.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,178.40
|
| Rate for Payer: Cigna of CA HMO |
$1,742.72
|
| Rate for Payer: Cigna of CA PPO |
$2,015.02
|
| 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 |
$2,314.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,633.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,450.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,042.25
|
| 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 |
$1,816.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$544.60
|
| 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 |
$2,042.25
|
| Rate for Payer: Networks By Design Commercial |
$1,769.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,314.55
|
| 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 |
$1,633.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,633.80
|
| 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: 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 SURVEY COMPLETE
|
Facility
|
IP
|
$2,723.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$2,450.70 |
| Rate for Payer: Cash Price |
$1,225.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,178.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,089.20
|
| Rate for Payer: Galaxy Health WC |
$2,314.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,633.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,450.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,816.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,037.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$544.60
|
| Rate for Payer: Multiplan Commercial |
$2,042.25
|
| Rate for Payer: Networks By Design Commercial |
$1,769.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,314.55
|
|
|
HC BONE SURVEY INFANT
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$373.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$373.48
|
| 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 |
$154.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.24
|
| Rate for Payer: Blue Distinction Transplant |
$244.20
|
| Rate for Payer: Blue Shield of California Commercial |
$251.53
|
| Rate for Payer: Blue Shield of California EPN |
$197.80
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Central Health Plan Commercial |
$325.60
|
| Rate for Payer: Cigna of CA HMO |
$260.48
|
| Rate for Payer: Cigna of CA PPO |
$301.18
|
| 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 |
$345.95
|
| Rate for Payer: Global Benefits Group Commercial |
$244.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$366.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$305.25
|
| 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 |
$271.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.40
|
| 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 |
$305.25
|
| Rate for Payer: Networks By Design Commercial |
$264.55
|
| Rate for Payer: Prime Health Services Commercial |
$345.95
|
| 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 |
$244.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.20
|
| 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: 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 SURVEY INFANT
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$366.30 |
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Central Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.80
|
| Rate for Payer: Galaxy Health WC |
$345.95
|
| Rate for Payer: Global Benefits Group Commercial |
$244.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$366.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$271.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.40
|
| Rate for Payer: Multiplan Commercial |
$305.25
|
| Rate for Payer: Networks By Design Commercial |
$264.55
|
| Rate for Payer: Prime Health Services Commercial |
$345.95
|
|
|
HC BOOT CAST PEDS LG
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901692802
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| 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 |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| 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 Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| 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: 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
|
| 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 Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC BOOT CAST PEDS LG
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901692802
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
|
|
HC BOOT CAST PEDS MED
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901692801
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
|
|
HC BOOT CAST PEDS MED
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901692801
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| 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 |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| 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 Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| 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: 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
|
| 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 Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC BOOT CAST PEDS SM
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901692800
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| 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 |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| 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 Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| 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: 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
|
| 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 Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC BOOT CAST PEDS SM
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901692800
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
|
|
HC BOOT MULTIPODUS CHILD
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604776
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Blue Shield of California EPN |
$309.72
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.01
|
| Rate for Payer: United Healthcare All Other HMO |
$213.90
|
| Rate for Payer: United Healthcare HMO Rider |
$209.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
|
|
HC BOOT MULTIPODUS CHILD
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604776
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.71 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.66
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$435.00
|
| Rate for Payer: Blue Shield of California EPN |
$315.52
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Media |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.80
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC BOOT MULTIPODUS SMALL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.50
|
| Rate for Payer: Blue Shield of California EPN |
$190.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BOOT MULTIPODUS SMALL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Blue Shield of California EPN |
$186.90
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.16
|
| Rate for Payer: United Healthcare All Other HMO |
$129.08
|
| Rate for Payer: United Healthcare HMO Rider |
$126.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.50
|
|
|
HC BOOT MULTIPODUS TODDLER
|
Facility
|
IP
|
$550.94
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604929
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.19 |
| Max. Negotiated Rate |
$495.85 |
| Rate for Payer: Blue Shield of California EPN |
$294.20
|
| Rate for Payer: Cash Price |
$247.92
|
| Rate for Payer: Central Health Plan Commercial |
$440.75
|
| Rate for Payer: Cigna of CA HMO |
$385.66
|
| Rate for Payer: Cigna of CA PPO |
$385.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$220.38
|
| Rate for Payer: Galaxy Health WC |
$468.30
|
| Rate for Payer: Global Benefits Group Commercial |
$330.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.19
|
| Rate for Payer: Multiplan Commercial |
$413.20
|
| Rate for Payer: Networks By Design Commercial |
$275.47
|
| Rate for Payer: Prime Health Services Commercial |
$468.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.03
|
| Rate for Payer: United Healthcare All Other HMO |
$203.19
|
| Rate for Payer: United Healthcare HMO Rider |
$198.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.81
|
|
|
HC BOOT MULTIPODUS TODDLER
|
Facility
|
OP
|
$550.94
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604929
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.71 |
| Max. Negotiated Rate |
$495.85 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$266.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.50
|
| Rate for Payer: Blue Distinction Transplant |
$330.56
|
| Rate for Payer: Blue Shield of California Commercial |
$413.20
|
| Rate for Payer: Blue Shield of California EPN |
$299.71
|
| Rate for Payer: Cash Price |
$247.92
|
| Rate for Payer: Cash Price |
$247.92
|
| Rate for Payer: Central Health Plan Commercial |
$440.75
|
| Rate for Payer: Cigna of CA HMO |
$385.66
|
| Rate for Payer: Cigna of CA PPO |
$385.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.30
|
| Rate for Payer: Dignity Health Media |
$468.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$220.38
|
| Rate for Payer: Galaxy Health WC |
$468.30
|
| Rate for Payer: Global Benefits Group Commercial |
$330.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.85
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$413.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$192.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.89
|
| Rate for Payer: Multiplan Commercial |
$413.20
|
| Rate for Payer: Networks By Design Commercial |
$275.47
|
| Rate for Payer: Prime Health Services Commercial |
$468.30
|
| Rate for Payer: Riverside University Health System MISP |
$220.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$275.47
|
| Rate for Payer: United Healthcare All Other HMO |
$275.47
|
| Rate for Payer: United Healthcare HMO Rider |
$275.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$275.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.30
|
| Rate for Payer: Vantage Medical Group Senior |
$468.30
|
|
