|
HC TC-99M PERTECHNETATE PER MCI
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT A9512
|
| Hospital Charge Code |
909301501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.25
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.90
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$143.50
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Other HMO |
$104.84
|
| Rate for Payer: United Healthcare HMO Rider |
$102.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
HC TC-99M PERTECHNETATE PER MCI
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT A9512
|
| Hospital Charge Code |
909301501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Blue Shield of California Commercial |
$211.81
|
| Rate for Payer: Blue Shield of California EPN |
$139.48
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$143.50
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Other HMO |
$104.84
|
| Rate for Payer: United Healthcare HMO Rider |
$102.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.99
|
|
|
HC TC-99 OXIDRONATE/HDP LT 30MCI
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT A9561
|
| Hospital Charge Code |
909301536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.68 |
| Max. Negotiated Rate |
$349.35 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.40
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Cigna of CA HMO |
$287.70
|
| Rate for Payer: Cigna of CA PPO |
$287.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$349.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$349.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$254.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.70
|
| Rate for Payer: Multiplan Commercial |
$328.80
|
| Rate for Payer: Networks By Design Commercial |
$205.50
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$154.25
|
| Rate for Payer: United Healthcare All Other HMO |
$150.14
|
| Rate for Payer: United Healthcare HMO Rider |
$146.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$349.35
|
| Rate for Payer: Vantage Medical Group Senior |
$349.35
|
|
|
HC TC-99 OXIDRONATE/HDP LT 30MCI
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT A9561
|
| Hospital Charge Code |
909301536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$349.35 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Blue Shield of California Commercial |
$303.32
|
| Rate for Payer: Blue Shield of California EPN |
$199.75
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Cigna of CA HMO |
$287.70
|
| Rate for Payer: Cigna of CA PPO |
$287.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$254.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.64
|
| Rate for Payer: Multiplan Commercial |
$328.80
|
| Rate for Payer: Networks By Design Commercial |
$205.50
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$154.25
|
| Rate for Payer: United Healthcare All Other HMO |
$150.14
|
| Rate for Payer: United Healthcare HMO Rider |
$146.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.60
|
|
|
HC TC-99 PENTETATE/DTPA LT 25MCI
|
Facility
|
IP
|
$1,036.00
|
|
|
Service Code
|
CPT A9539
|
| Hospital Charge Code |
909301510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.20 |
| Max. Negotiated Rate |
$880.60 |
| Rate for Payer: Adventist Health Commercial |
$207.20
|
| Rate for Payer: Blue Shield of California Commercial |
$764.57
|
| Rate for Payer: Blue Shield of California EPN |
$503.50
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna of CA HMO |
$725.20
|
| Rate for Payer: Cigna of CA PPO |
$725.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.40
|
| Rate for Payer: EPIC Health Plan Senior |
$414.40
|
| Rate for Payer: Galaxy Health WC |
$880.60
|
| Rate for Payer: Global Benefits Group Commercial |
$621.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$691.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$641.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.64
|
| Rate for Payer: Multiplan Commercial |
$828.80
|
| Rate for Payer: Networks By Design Commercial |
$518.00
|
| Rate for Payer: Prime Health Services Commercial |
$880.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$388.81
|
| Rate for Payer: United Healthcare All Other HMO |
$378.45
|
| Rate for Payer: United Healthcare HMO Rider |
$370.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$339.29
|
|
|
HC TC-99 PENTETATE/DTPA LT 25MCI
|
Facility
|
OP
|
$1,036.00
|
|
|
Service Code
|
CPT A9539
|
| Hospital Charge Code |
909301510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$880.60 |
| Rate for Payer: Adventist Health Commercial |
$207.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$880.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$569.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.21
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna of CA HMO |
$725.20
|
| Rate for Payer: Cigna of CA PPO |
$725.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$880.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$880.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$880.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.40
|
| Rate for Payer: EPIC Health Plan Senior |
$414.40
|
| Rate for Payer: Galaxy Health WC |
$880.60
|
| Rate for Payer: Global Benefits Group Commercial |
$621.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$691.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$641.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$725.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$725.20
|
| Rate for Payer: Multiplan Commercial |
$828.80
|
| Rate for Payer: Networks By Design Commercial |
$518.00
|
| Rate for Payer: Prime Health Services Commercial |
$880.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$621.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$388.81
|
| Rate for Payer: United Healthcare All Other HMO |
$378.45
|
| Rate for Payer: United Healthcare HMO Rider |
$370.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$339.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$880.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$880.60
|
| Rate for Payer: Vantage Medical Group Senior |
$880.60
|
|
|
HC TC-99 PYROPHOSPHATE LT 25 MCI
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
909301507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.80 |
| Max. Negotiated Rate |
$521.90 |
| Rate for Payer: Adventist Health Commercial |
$122.80
|
| Rate for Payer: Blue Shield of California Commercial |
$453.13
|
| Rate for Payer: Blue Shield of California EPN |
$298.40
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cigna of CA HMO |
$429.80
|
| Rate for Payer: Cigna of CA PPO |
$429.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.60
|
| Rate for Payer: EPIC Health Plan Senior |
$245.60
|
| Rate for Payer: Galaxy Health WC |
$521.90
|
| Rate for Payer: Global Benefits Group Commercial |
$368.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$409.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$380.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.36
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: Networks By Design Commercial |
$307.00
|
| Rate for Payer: Prime Health Services Commercial |
$521.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.43
|
| Rate for Payer: United Healthcare All Other HMO |
$224.29
|
| Rate for Payer: United Healthcare HMO Rider |
$219.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.09
|
|
|
HC TC-99 PYROPHOSPHATE LT 25 MCI
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
909301507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$521.90 |
| Rate for Payer: Adventist Health Commercial |
$122.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$521.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$460.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$377.06
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cigna of CA HMO |
$429.80
|
| Rate for Payer: Cigna of CA PPO |
$429.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$521.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$521.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$521.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.60
|
| Rate for Payer: EPIC Health Plan Senior |
$245.60
|
| Rate for Payer: Galaxy Health WC |
$521.90
|
| Rate for Payer: Global Benefits Group Commercial |
$368.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$107.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$409.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$380.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$429.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$429.80
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: Networks By Design Commercial |
$307.00
|
| Rate for Payer: Prime Health Services Commercial |
$521.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$368.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$368.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.43
|
| Rate for Payer: United Healthcare All Other HMO |
$224.29
|
| Rate for Payer: United Healthcare HMO Rider |
$219.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$521.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$521.90
|
| Rate for Payer: Vantage Medical Group Senior |
$521.90
|
|
|
HC TC-99 SUCCIMER/DMSA LT 10 MCI
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT A9551
|
| Hospital Charge Code |
909301500
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$600.10 |
| Rate for Payer: Adventist Health Commercial |
$141.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$600.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$388.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$529.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$433.55
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cigna of CA HMO |
$494.20
|
| Rate for Payer: Cigna of CA PPO |
$494.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$600.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$600.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$600.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$170.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$437.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.20
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: Networks By Design Commercial |
$353.00
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$423.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Other HMO |
$257.90
|
| Rate for Payer: United Healthcare HMO Rider |
$252.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$231.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$600.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$600.10
|
| Rate for Payer: Vantage Medical Group Senior |
$600.10
|
|
|
HC TC-99 SUCCIMER/DMSA LT 10 MCI
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT A9551
|
| Hospital Charge Code |
909301500
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$600.10 |
| Rate for Payer: Adventist Health Commercial |
$141.20
|
| Rate for Payer: Blue Shield of California Commercial |
$521.03
|
| Rate for Payer: Blue Shield of California EPN |
$343.12
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cigna of CA HMO |
$494.20
|
| Rate for Payer: Cigna of CA PPO |
$494.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$437.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.44
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: Networks By Design Commercial |
$353.00
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Other HMO |
$257.90
|
| Rate for Payer: United Healthcare HMO Rider |
$252.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$231.22
|
|
|
HC TC-99 TETROFOSMN/MYOVIEW LT 40MCI
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
CPT A9502
|
| Hospital Charge Code |
909301544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.40 |
| Max. Negotiated Rate |
$498.95 |
| Rate for Payer: Adventist Health Commercial |
$117.40
|
| Rate for Payer: Blue Shield of California Commercial |
$433.21
|
| Rate for Payer: Blue Shield of California EPN |
$285.28
|
| Rate for Payer: Cash Price |
$264.15
|
| Rate for Payer: Cigna of CA HMO |
$410.90
|
| Rate for Payer: Cigna of CA PPO |
$410.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.80
|
| Rate for Payer: EPIC Health Plan Senior |
$234.80
|
| Rate for Payer: Galaxy Health WC |
$498.95
|
| Rate for Payer: Global Benefits Group Commercial |
$352.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$391.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.88
|
| Rate for Payer: Multiplan Commercial |
$469.60
|
| Rate for Payer: Networks By Design Commercial |
$293.50
|
| Rate for Payer: Prime Health Services Commercial |
$498.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.30
|
| Rate for Payer: United Healthcare All Other HMO |
$214.43
|
| Rate for Payer: United Healthcare HMO Rider |
$209.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$192.24
|
|
|
HC TC-99 TETROFOSMN/MYOVIEW LT 40MCI
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
CPT A9502
|
| Hospital Charge Code |
909301544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.40 |
| Max. Negotiated Rate |
$498.95 |
| Rate for Payer: Adventist Health Commercial |
$117.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$498.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$322.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$440.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.48
|
| Rate for Payer: Cash Price |
$264.15
|
| Rate for Payer: Cash Price |
$264.15
|
| Rate for Payer: Cigna of CA HMO |
$410.90
|
| Rate for Payer: Cigna of CA PPO |
$410.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$498.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$498.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$498.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.80
|
| Rate for Payer: EPIC Health Plan Senior |
$234.80
|
| Rate for Payer: Galaxy Health WC |
$498.95
|
| Rate for Payer: Global Benefits Group Commercial |
$352.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$391.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.90
|
| Rate for Payer: Multiplan Commercial |
$469.60
|
| Rate for Payer: Networks By Design Commercial |
$293.50
|
| Rate for Payer: Prime Health Services Commercial |
$498.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$352.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$352.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.30
|
| Rate for Payer: United Healthcare All Other HMO |
$214.43
|
| Rate for Payer: United Healthcare HMO Rider |
$209.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$192.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$498.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$498.95
|
| Rate for Payer: Vantage Medical Group Senior |
$498.95
|
|
|
HC TC-99 ULTRATAG UP TO 30 MCI
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
CPT A9560
|
| Hospital Charge Code |
909301534
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$685.10 |
| Rate for Payer: Adventist Health Commercial |
$161.20
|
| Rate for Payer: Blue Shield of California Commercial |
$594.83
|
| Rate for Payer: Blue Shield of California EPN |
$391.72
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.44
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
|
|
HC TC-99 ULTRATAG UP TO 30 MCI
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
CPT A9560
|
| Hospital Charge Code |
909301534
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.02 |
| Max. Negotiated Rate |
$685.10 |
| Rate for Payer: Adventist Health Commercial |
$161.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$604.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$494.96
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$685.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.20
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.10
|
| Rate for Payer: Vantage Medical Group Senior |
$685.10
|
|
|
HC TCATH RMVL OR DBLK ICAR MASS OR VEG
|
Facility
|
OP
|
$13,368.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
906820292
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,673.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,209.29
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$6,015.60
|
| Rate for Payer: Cash Price |
$6,015.60
|
| Rate for Payer: Cash Price |
$6,015.60
|
| Rate for Payer: Cigna of CA HMO |
$8,689.20
|
| Rate for Payer: Cigna of CA PPO |
$9,892.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$11,362.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,020.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,916.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,093.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,208.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$10,694.40
|
| Rate for Payer: Networks By Design Commercial |
$8,689.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,362.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,020.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,020.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC TCATH RMVL OR DBLK ICAR MASS OR VEG
|
Facility
|
IP
|
$13,368.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
906820292
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,673.60 |
| Max. Negotiated Rate |
$11,362.80 |
| Rate for Payer: Adventist Health Commercial |
$2,673.60
|
| Rate for Payer: Cash Price |
$6,015.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,347.20
|
| Rate for Payer: Galaxy Health WC |
$11,362.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,020.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,916.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,093.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,274.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,208.32
|
| Rate for Payer: Multiplan Commercial |
$10,694.40
|
| Rate for Payer: Networks By Design Commercial |
$8,689.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,362.80
|
|
|
HC TCATH RMVL OR DBLK ICAR MASS OR VEG
|
Facility
|
IP
|
$13,755.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
906811644
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,751.00 |
| Max. Negotiated Rate |
$11,691.75 |
| Rate for Payer: Adventist Health Commercial |
$2,751.00
|
| Rate for Payer: Cash Price |
$6,189.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,502.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,502.00
|
| Rate for Payer: Galaxy Health WC |
$11,691.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,253.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,174.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,240.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,514.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,301.20
|
| Rate for Payer: Multiplan Commercial |
$11,004.00
|
| Rate for Payer: Networks By Design Commercial |
$8,940.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,691.75
|
|
|
HC TCATH RMVL OR DBLK ICAR MASS OR VEG
|
Facility
|
OP
|
$13,755.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
906811644
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,751.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,446.95
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$6,189.75
|
| Rate for Payer: Cash Price |
$6,189.75
|
| Rate for Payer: Cash Price |
$6,189.75
|
| Rate for Payer: Cigna of CA HMO |
$8,940.75
|
| Rate for Payer: Cigna of CA PPO |
$10,178.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$11,691.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,253.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,174.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,240.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,301.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$11,004.00
|
| Rate for Payer: Networks By Design Commercial |
$8,940.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,691.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,253.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,253.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC TCAT IMPL WRLS L ATR PRS SNR
|
Facility
|
IP
|
$8,783.00
|
|
|
Service Code
|
CPT 0933T
|
| Hospital Charge Code |
906811517
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,756.60 |
| Max. Negotiated Rate |
$7,465.55 |
| Rate for Payer: Adventist Health Commercial |
$1,756.60
|
| Rate for Payer: Cash Price |
$3,952.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,513.20
|
| Rate for Payer: Galaxy Health WC |
$7,465.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,269.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,858.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,346.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,436.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,107.92
|
| Rate for Payer: Multiplan Commercial |
$7,026.40
|
| Rate for Payer: Networks By Design Commercial |
$5,708.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,465.55
|
|
|
HC TCAT IMPL WRLS L ATR PRS SNR
|
Facility
|
OP
|
$8,783.00
|
|
|
Service Code
|
CPT 0933T
|
| Hospital Charge Code |
906811517
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Adventist Health Commercial |
$1,756.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,393.64
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$3,952.35
|
| Rate for Payer: Cash Price |
$3,952.35
|
| Rate for Payer: Cash Price |
$3,952.35
|
| Rate for Payer: Cigna of CA HMO |
$5,621.12
|
| Rate for Payer: Cigna of CA PPO |
$6,499.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$7,465.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,269.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,858.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,346.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,107.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$7,026.40
|
| Rate for Payer: Networks By Design Commercial |
$5,708.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,465.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,269.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,269.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC TCAT IMPL WRLS PUL ART PRS SNR
|
Facility
|
IP
|
$20,837.00
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
906820143
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$4,167.40 |
| Max. Negotiated Rate |
$17,711.45 |
| Rate for Payer: Adventist Health Commercial |
$4,167.40
|
| Rate for Payer: Cash Price |
$9,376.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,334.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,334.80
|
| Rate for Payer: Galaxy Health WC |
$17,711.45
|
| Rate for Payer: Global Benefits Group Commercial |
$12,502.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,898.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,938.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,898.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.88
|
| Rate for Payer: Multiplan Commercial |
$16,669.60
|
| Rate for Payer: Networks By Design Commercial |
$13,544.05
|
| Rate for Payer: Prime Health Services Commercial |
$17,711.45
|
|
|
HC TCAT IMPL WRLS PUL ART PRS SNR
|
Facility
|
OP
|
$20,837.00
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
906820143
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$463.46 |
| Max. Negotiated Rate |
$59,238.51 |
| Rate for Payer: Adventist Health Commercial |
$4,167.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54,181.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39,733.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,121.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,752.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,418.15
|
| Rate for Payer: Cash Price |
$9,376.65
|
| Rate for Payer: Cash Price |
$9,376.65
|
| Rate for Payer: Cash Price |
$9,376.65
|
| Rate for Payer: Cigna of CA HMO |
$13,335.68
|
| Rate for Payer: Cigna of CA PPO |
$15,419.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54,181.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$39,733.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36,121.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,763.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36,121.04
|
| Rate for Payer: Galaxy Health WC |
$17,711.45
|
| Rate for Payer: Global Benefits Group Commercial |
$12,502.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$59,238.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$463.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,121.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,898.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$524.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,121.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,512.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,402.19
|
| Rate for Payer: Multiplan Commercial |
$16,669.60
|
| Rate for Payer: Networks By Design Commercial |
$13,544.05
|
| Rate for Payer: Prime Health Services Commercial |
$17,711.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,502.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,502.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$36,121.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54,181.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,733.14
|
| Rate for Payer: Vantage Medical Group Senior |
$36,121.04
|
|
|
HC TCAT IMPL WRLS PUL ART PRS SNR
|
Facility
|
OP
|
$21,440.00
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
906811492
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$463.46 |
| Max. Negotiated Rate |
$59,238.51 |
| Rate for Payer: Adventist Health Commercial |
$4,288.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54,181.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39,733.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,121.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,121.28
|
| Rate for Payer: Blue Shield of California EPN |
$8,661.76
|
| Rate for Payer: Cash Price |
$9,648.00
|
| Rate for Payer: Cash Price |
$9,648.00
|
| Rate for Payer: Cash Price |
$9,648.00
|
| Rate for Payer: Cigna of CA HMO |
$13,721.60
|
| Rate for Payer: Cigna of CA PPO |
$15,865.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54,181.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$39,733.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36,121.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,763.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36,121.04
|
| Rate for Payer: Galaxy Health WC |
$18,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,864.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$59,238.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$463.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,121.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,300.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$524.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,121.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,145.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,512.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,402.19
|
| Rate for Payer: Multiplan Commercial |
$17,152.00
|
| Rate for Payer: Networks By Design Commercial |
$13,936.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,864.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,864.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$36,121.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54,181.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,733.14
|
| Rate for Payer: Vantage Medical Group Senior |
$36,121.04
|
|
|
HC TCAT IMPL WRLS PUL ART PRS SNR
|
Facility
|
IP
|
$21,440.00
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
906811492
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$4,288.00 |
| Max. Negotiated Rate |
$18,224.00 |
| Rate for Payer: Adventist Health Commercial |
$4,288.00
|
| Rate for Payer: Cash Price |
$9,648.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,576.00
|
| Rate for Payer: Galaxy Health WC |
$18,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,864.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,300.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,168.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,271.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,145.60
|
| Rate for Payer: Multiplan Commercial |
$17,152.00
|
| Rate for Payer: Networks By Design Commercial |
$13,936.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,224.00
|
|
|
HC TCAT INTRA COR INFUS SUPSAT OXY
|
Facility
|
IP
|
$2,095.00
|
|
|
Service Code
|
CPT 0659T
|
| Hospital Charge Code |
906810659
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$419.00 |
| Max. Negotiated Rate |
$1,780.75 |
| Rate for Payer: Adventist Health Commercial |
$419.00
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$838.00
|
| Rate for Payer: Galaxy Health WC |
$1,780.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,397.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$798.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,296.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$502.80
|
| Rate for Payer: Multiplan Commercial |
$1,676.00
|
| Rate for Payer: Networks By Design Commercial |
$1,361.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,780.75
|
|
