|
HC TC-99 GHT UP TO 25 MCI
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT A9550
|
| Hospital Charge Code |
909301509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$217.60 |
| Rate for Payer: Adventist Health Commercial |
$51.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$217.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.00
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$179.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$217.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$217.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$179.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.40
|
| Rate for Payer: EPIC Health Plan Senior |
$102.40
|
| Rate for Payer: Galaxy Health WC |
$217.60
|
| Rate for Payer: Global Benefits Group Commercial |
$153.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$162.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$179.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$179.20
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: Networks By Design Commercial |
$128.00
|
| Rate for Payer: Prime Health Services Commercial |
$217.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.08
|
| Rate for Payer: United Healthcare All Other HMO |
$93.52
|
| Rate for Payer: United Healthcare HMO Rider |
$91.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$217.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$217.60
|
| Rate for Payer: Vantage Medical Group Senior |
$217.60
|
|
|
HC TC-99 GHT UP TO 25 MCI
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT A9550
|
| Hospital Charge Code |
909301509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$217.60 |
| Rate for Payer: Adventist Health Commercial |
$51.20
|
| Rate for Payer: Blue Shield of California Commercial |
$129.79
|
| Rate for Payer: Blue Shield of California Commercial |
$196.86
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$179.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$179.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.40
|
| Rate for Payer: EPIC Health Plan Senior |
$102.40
|
| Rate for Payer: Galaxy Health WC |
$217.60
|
| Rate for Payer: Global Benefits Group Commercial |
$153.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$162.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.44
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: Networks By Design Commercial |
$128.00
|
| Rate for Payer: Prime Health Services Commercial |
$217.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.08
|
| Rate for Payer: United Healthcare All Other HMO |
$93.52
|
| Rate for Payer: United Healthcare HMO Rider |
$91.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.84
|
|
|
HC TC-99 HEPATOLITE UP TO 15 MCI
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT A9510
|
| Hospital Charge Code |
909301505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Blue Shield of California Commercial |
$227.64
|
| Rate for Payer: Blue Shield of California Commercial |
$345.28
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
|
|
HC TC-99 HEPATOLITE UP TO 15 MCI
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT A9510
|
| Hospital Charge Code |
909301505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.51 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.74
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$381.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$381.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$314.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$314.30
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$381.65
|
| Rate for Payer: Vantage Medical Group Senior |
$381.65
|
|
|
HC TC-99 MAA UP TO 10 MCI
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT A9540
|
| Hospital Charge Code |
909301506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Blue Shield of California Commercial |
$149.06
|
| Rate for Payer: Blue Shield of California Commercial |
$226.09
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna of CA HMO |
$205.80
|
| Rate for Payer: Cigna of CA PPO |
$205.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.56
|
| Rate for Payer: Multiplan Commercial |
$235.20
|
| Rate for Payer: Networks By Design Commercial |
$147.00
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.34
|
| Rate for Payer: United Healthcare All Other HMO |
$107.40
|
| Rate for Payer: United Healthcare HMO Rider |
$105.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.28
|
|
|
HC TC-99 MAA UP TO 10 MCI
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT A9540
|
| Hospital Charge Code |
909301506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.93
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna of CA HMO |
$205.80
|
| Rate for Payer: Cigna of CA PPO |
$205.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$235.20
|
| Rate for Payer: Networks By Design Commercial |
$147.00
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.34
|
| Rate for Payer: United Healthcare All Other HMO |
$107.40
|
| Rate for Payer: United Healthcare HMO Rider |
$105.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
|
|
HC TC-99M APCITIDE/ACCUTEC LT 20MCI
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
CPT A9504
|
| Hospital Charge Code |
909301540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$386.60 |
| Max. Negotiated Rate |
$1,643.05 |
| Rate for Payer: Adventist Health Commercial |
$386.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,643.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,063.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,449.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,064.52
|
| Rate for Payer: Cash Price |
$869.85
|
| Rate for Payer: Cash Price |
$869.85
|
| Rate for Payer: Cigna of CA HMO |
$1,353.10
|
| Rate for Payer: Cigna of CA PPO |
$1,353.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,643.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,643.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,643.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,353.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$773.20
|
| Rate for Payer: EPIC Health Plan Senior |
$773.20
|
| Rate for Payer: Galaxy Health WC |
$1,643.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,159.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$638.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,227.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,140.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$463.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,353.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,353.10
|
| Rate for Payer: Multiplan Commercial |
$1,546.40
|
| Rate for Payer: Networks By Design Commercial |
$966.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,643.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,159.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,159.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.45
|
| Rate for Payer: United Healthcare All Other HMO |
$706.12
|
| Rate for Payer: United Healthcare HMO Rider |
$690.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$633.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,643.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,643.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,643.05
|
|
|
HC TC-99M APCITIDE/ACCUTEC LT 20MCI
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
CPT A9504
|
| Hospital Charge Code |
909301540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$386.60 |
| Max. Negotiated Rate |
$1,643.05 |
| Rate for Payer: Cigna of CA HMO |
$1,353.10
|
| Rate for Payer: Adventist Health Commercial |
$386.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,486.48
|
| Rate for Payer: Blue Shield of California Commercial |
$980.03
|
| Rate for Payer: Cash Price |
$869.85
|
| Rate for Payer: Cigna of CA PPO |
$1,353.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,353.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$773.20
|
| Rate for Payer: EPIC Health Plan Senior |
$773.20
|
| Rate for Payer: Galaxy Health WC |
$1,643.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,159.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,227.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,140.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$463.92
|
| Rate for Payer: Multiplan Commercial |
$1,546.40
|
| Rate for Payer: Networks By Design Commercial |
$966.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,643.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.45
|
| Rate for Payer: United Healthcare All Other HMO |
$706.12
|
| Rate for Payer: United Healthcare HMO Rider |
$690.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$633.06
|
|
|
HC TC-99M DEPREOTID NEOTEC LT 35MCI
|
Facility
|
OP
|
$2,398.00
|
|
|
Service Code
|
CPT A9536
|
| Hospital Charge Code |
909301542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$479.60 |
| Max. Negotiated Rate |
$2,038.30 |
| Rate for Payer: Adventist Health Commercial |
$479.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,038.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,318.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,798.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,797.86
|
| Rate for Payer: Cash Price |
$1,079.10
|
| Rate for Payer: Cash Price |
$1,079.10
|
| Rate for Payer: Cigna of CA HMO |
$1,678.60
|
| Rate for Payer: Cigna of CA PPO |
$1,678.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,038.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,038.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,678.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$959.20
|
| Rate for Payer: EPIC Health Plan Senior |
$959.20
|
| Rate for Payer: Galaxy Health WC |
$2,038.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,438.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,021.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,522.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,155.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,414.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,678.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,678.60
|
| Rate for Payer: Multiplan Commercial |
$1,918.40
|
| Rate for Payer: Networks By Design Commercial |
$1,199.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,038.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,438.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,438.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$899.97
|
| Rate for Payer: United Healthcare All Other HMO |
$875.99
|
| Rate for Payer: United Healthcare HMO Rider |
$857.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$785.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,038.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,038.30
|
|
|
HC TC-99M DEPREOTID NEOTEC LT 35MCI
|
Facility
|
IP
|
$2,398.00
|
|
|
Service Code
|
CPT A9536
|
| Hospital Charge Code |
909301542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$479.60 |
| Max. Negotiated Rate |
$2,038.30 |
| Rate for Payer: Adventist Health Commercial |
$479.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,215.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,844.06
|
| Rate for Payer: Cash Price |
$1,079.10
|
| Rate for Payer: Cigna of CA HMO |
$1,678.60
|
| Rate for Payer: Cigna of CA PPO |
$1,678.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,678.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$959.20
|
| Rate for Payer: EPIC Health Plan Senior |
$959.20
|
| Rate for Payer: Galaxy Health WC |
$2,038.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,438.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,522.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,414.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.52
|
| Rate for Payer: Multiplan Commercial |
$1,918.40
|
| Rate for Payer: Networks By Design Commercial |
$1,199.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,038.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$899.97
|
| Rate for Payer: United Healthcare All Other HMO |
$875.99
|
| Rate for Payer: United Healthcare HMO Rider |
$857.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$785.35
|
|
|
HC TC-99 MEBROFEN/CHOLETEC LT 15MCI
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT A9537
|
| Hospital Charge Code |
909301537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$923.10 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Blue Shield of California Commercial |
$550.60
|
| Rate for Payer: Blue Shield of California Commercial |
$835.13
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna of CA HMO |
$760.20
|
| Rate for Payer: Cigna of CA PPO |
$760.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$760.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$689.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$640.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.64
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Networks By Design Commercial |
$543.00
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$407.58
|
| Rate for Payer: United Healthcare All Other HMO |
$396.72
|
| Rate for Payer: United Healthcare HMO Rider |
$388.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$355.67
|
|
|
HC TC-99 MEBROFEN/CHOLETEC LT 15MCI
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT A9537
|
| Hospital Charge Code |
909301537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.20 |
| Max. Negotiated Rate |
$923.10 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$923.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$597.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$814.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.85
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna of CA HMO |
$760.20
|
| Rate for Payer: Cigna of CA PPO |
$760.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$923.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$923.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$760.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$689.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$640.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$760.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.20
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Networks By Design Commercial |
$543.00
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$651.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$651.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$407.58
|
| Rate for Payer: United Healthcare All Other HMO |
$396.72
|
| Rate for Payer: United Healthcare HMO Rider |
$388.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$355.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$923.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.10
|
| Rate for Payer: Vantage Medical Group Senior |
$923.10
|
|
|
HC TC-99 MEDRONATE/MDP LT 30MCI
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT A9503
|
| Hospital Charge Code |
909301508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$345.69 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$345.69
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna of CA HMO |
$205.80
|
| Rate for Payer: Cigna of CA PPO |
$205.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$235.20
|
| Rate for Payer: Networks By Design Commercial |
$147.00
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.34
|
| Rate for Payer: United Healthcare All Other HMO |
$107.40
|
| Rate for Payer: United Healthcare HMO Rider |
$105.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
|
|
HC TC-99 MEDRONATE/MDP LT 30MCI
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT A9503
|
| Hospital Charge Code |
909301508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Blue Shield of California Commercial |
$149.06
|
| Rate for Payer: Blue Shield of California Commercial |
$226.09
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna of CA HMO |
$205.80
|
| Rate for Payer: Cigna of CA PPO |
$205.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.56
|
| Rate for Payer: Multiplan Commercial |
$235.20
|
| Rate for Payer: Networks By Design Commercial |
$147.00
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.34
|
| Rate for Payer: United Healthcare All Other HMO |
$107.40
|
| Rate for Payer: United Healthcare HMO Rider |
$105.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.28
|
|
|
HC TC-99 MERTIATIDE/MAG3 LT 15MCI
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
CPT A9562
|
| Hospital Charge Code |
909301531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$399.40 |
| Max. Negotiated Rate |
$1,697.45 |
| Rate for Payer: Adventist Health Commercial |
$399.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,012.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1,535.69
|
| Rate for Payer: Cash Price |
$898.65
|
| Rate for Payer: Cigna of CA HMO |
$1,397.90
|
| Rate for Payer: Cigna of CA PPO |
$1,397.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,397.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$798.80
|
| Rate for Payer: EPIC Health Plan Senior |
$798.80
|
| Rate for Payer: Galaxy Health WC |
$1,697.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,198.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,268.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,178.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.28
|
| Rate for Payer: Multiplan Commercial |
$1,597.60
|
| Rate for Payer: Networks By Design Commercial |
$998.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,697.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$749.47
|
| Rate for Payer: United Healthcare All Other HMO |
$729.50
|
| Rate for Payer: United Healthcare HMO Rider |
$713.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.02
|
|
|
HC TC-99 MERTIATIDE/MAG3 LT 15MCI
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
CPT A9562
|
| Hospital Charge Code |
909301531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$399.40 |
| Max. Negotiated Rate |
$1,697.45 |
| Rate for Payer: Adventist Health Commercial |
$399.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,697.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,098.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,497.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,053.90
|
| Rate for Payer: Cash Price |
$898.65
|
| Rate for Payer: Cash Price |
$898.65
|
| Rate for Payer: Cigna of CA HMO |
$1,397.90
|
| Rate for Payer: Cigna of CA PPO |
$1,397.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,697.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,697.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,697.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,397.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$798.80
|
| Rate for Payer: EPIC Health Plan Senior |
$798.80
|
| Rate for Payer: Galaxy Health WC |
$1,697.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,198.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$515.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,268.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$583.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,178.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,397.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,397.90
|
| Rate for Payer: Multiplan Commercial |
$1,597.60
|
| Rate for Payer: Networks By Design Commercial |
$998.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,697.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,198.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,198.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$749.47
|
| Rate for Payer: United Healthcare All Other HMO |
$729.50
|
| Rate for Payer: United Healthcare HMO Rider |
$713.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,697.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,697.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,697.45
|
|
|
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 |
$4.09 |
| 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 |
$4.09
|
| Rate for Payer: Cash Price |
$129.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.33
|
| 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 |
$145.51
|
| Rate for Payer: Blue Shield of California Commercial |
$220.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.33
|
| 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 |
$77.66
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.49
|
| 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 |
$208.38
|
| Rate for Payer: Blue Shield of California Commercial |
$316.06
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$260.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.49
|
| 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 |
$525.25
|
| Rate for Payer: Blue Shield of California Commercial |
$796.68
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$657.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$611.24
|
| 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 |
$38.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$611.24
|
| 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 |
$311.30
|
| Rate for Payer: Blue Shield of California Commercial |
$472.17
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$389.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$362.26
|
| 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 |
$58.43 |
| 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 |
$58.43
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$107.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$362.26
|
| 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
|
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 |
$357.94
|
| Rate for Payer: Blue Shield of California Commercial |
$542.91
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$448.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$416.54
|
| 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
|
|
