|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
909073502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$661.30 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$205.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$359.19
|
| Rate for Payer: Blue Shield of California Commercial |
$327.54
|
| Rate for Payer: Blue Shield of California Commercial |
$496.36
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cigna of CA HMO |
$497.92
|
| Rate for Payer: Cigna of CA PPO |
$575.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$544.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$494.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$505.70
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$466.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$466.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.65
|
| Rate for Payer: United Healthcare All Other HMO |
$155.65
|
| Rate for Payer: United Healthcare HMO Rider |
$155.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
909073502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.60 |
| Max. Negotiated Rate |
$661.30 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$544.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$494.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$505.70
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
|
|
HC XRAY HIP W/PELVIS UNI 4 GT VIEWS
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
909073503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$652.80 |
| Rate for Payer: Adventist Health Commercial |
$153.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$537.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.20
|
| Rate for Payer: EPIC Health Plan Senior |
$307.20
|
| Rate for Payer: Galaxy Health WC |
$652.80
|
| Rate for Payer: Global Benefits Group Commercial |
$460.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$487.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.32
|
| Rate for Payer: Multiplan Commercial |
$614.40
|
| Rate for Payer: Networks By Design Commercial |
$499.20
|
| Rate for Payer: Prime Health Services Commercial |
$652.80
|
|
|
HC XRAY HIP W/PELVIS UNI 4 GT VIEWS
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
909073503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.24 |
| Max. Negotiated Rate |
$652.80 |
| Rate for Payer: Adventist Health Commercial |
$153.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$254.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$445.01
|
| Rate for Payer: Blue Shield of California Commercial |
$323.33
|
| Rate for Payer: Blue Shield of California Commercial |
$489.98
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna of CA HMO |
$491.52
|
| Rate for Payer: Cigna of CA PPO |
$568.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$537.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$652.80
|
| Rate for Payer: Global Benefits Group Commercial |
$460.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$487.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$614.40
|
| Rate for Payer: Networks By Design Commercial |
$499.20
|
| Rate for Payer: Prime Health Services Commercial |
$652.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$460.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$460.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.76
|
| Rate for Payer: United Healthcare All Other HMO |
$257.76
|
| Rate for Payer: United Healthcare HMO Rider |
$257.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY SKULL RADIOGRAPH LTD
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
908801144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$701.25 |
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$577.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$330.00
|
| Rate for Payer: Galaxy Health WC |
$701.25
|
| Rate for Payer: Global Benefits Group Commercial |
$495.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$523.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$486.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Multiplan Commercial |
$660.00
|
| Rate for Payer: Networks By Design Commercial |
$536.25
|
| Rate for Payer: Prime Health Services Commercial |
$701.25
|
|
|
HC XRAY SKULL RADIOGRAPH LTD
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
908801144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$701.25 |
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$180.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.59
|
| Rate for Payer: Blue Shield of California Commercial |
$347.32
|
| Rate for Payer: Blue Shield of California Commercial |
$526.35
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cigna of CA HMO |
$528.00
|
| Rate for Payer: Cigna of CA PPO |
$610.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$577.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$701.25
|
| Rate for Payer: Global Benefits Group Commercial |
$495.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$523.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$660.00
|
| Rate for Payer: Networks By Design Commercial |
$536.25
|
| Rate for Payer: Prime Health Services Commercial |
$701.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$495.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$495.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XR RIBS UNI & PA CHEST
|
Facility
|
IP
|
$872.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$741.20 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$610.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.80
|
| Rate for Payer: EPIC Health Plan Senior |
$348.80
|
| Rate for Payer: Galaxy Health WC |
$741.20
|
| Rate for Payer: Global Benefits Group Commercial |
$523.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$553.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$514.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.28
|
| Rate for Payer: Multiplan Commercial |
$697.60
|
| Rate for Payer: Networks By Design Commercial |
$566.80
|
| Rate for Payer: Prime Health Services Commercial |
$741.20
|
|
|
HC XR RIBS UNI & PA CHEST
|
Facility
|
OP
|
$872.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$741.20 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$190.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.81
|
| Rate for Payer: Blue Shield of California Commercial |
$367.11
|
| Rate for Payer: Blue Shield of California Commercial |
$556.34
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna of CA HMO |
$558.08
|
| Rate for Payer: Cigna of CA PPO |
$645.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$610.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$741.20
|
| Rate for Payer: Global Benefits Group Commercial |
$523.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$553.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$697.60
|
| Rate for Payer: Networks By Design Commercial |
$566.80
|
| Rate for Payer: Prime Health Services Commercial |
$741.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$523.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$523.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XR RIBS W PA CXR
|
Facility
|
IP
|
$1,110.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$943.50 |
| Rate for Payer: Adventist Health Commercial |
$222.00
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$777.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$444.00
|
| Rate for Payer: EPIC Health Plan Senior |
$444.00
|
| Rate for Payer: Galaxy Health WC |
$943.50
|
| Rate for Payer: Global Benefits Group Commercial |
$666.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$704.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$654.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.40
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$721.50
|
| Rate for Payer: Prime Health Services Commercial |
$943.50
|
|
|
HC XR RIBS W PA CXR
|
Facility
|
OP
|
$1,110.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.23 |
| Max. Negotiated Rate |
$943.50 |
| Rate for Payer: Adventist Health Commercial |
$222.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$268.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.41
|
| Rate for Payer: Blue Shield of California Commercial |
$467.31
|
| Rate for Payer: Blue Shield of California Commercial |
$708.18
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cigna of CA HMO |
$710.40
|
| Rate for Payer: Cigna of CA PPO |
$821.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$777.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$943.50
|
| Rate for Payer: Global Benefits Group Commercial |
$666.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$704.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$721.50
|
| Rate for Payer: Prime Health Services Commercial |
$943.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$666.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$666.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XR TEMP MANDIBULAR BILAT
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
909020170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.99 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Adventist Health Commercial |
$160.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.76
|
| Rate for Payer: Blue Shield of California Commercial |
$336.80
|
| Rate for Payer: Blue Shield of California Commercial |
$510.40
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna of CA HMO |
$512.00
|
| Rate for Payer: Cigna of CA PPO |
$592.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$560.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$680.00
|
| Rate for Payer: Global Benefits Group Commercial |
$480.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$508.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$680.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$480.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$480.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC XR TEMP MANDIBULAR BILAT
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
909020170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Adventist Health Commercial |
$160.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$560.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.00
|
| Rate for Payer: EPIC Health Plan Senior |
$320.00
|
| Rate for Payer: Galaxy Health WC |
$680.00
|
| Rate for Payer: Global Benefits Group Commercial |
$480.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$508.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$472.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$680.00
|
|
|
HC X STNT NUMED CP
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906881017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.50
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
|
|
HC X STNT NUMED CP
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906881017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.50
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
HC XYLOSE TOLERANCE BLD
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 84620
|
| Hospital Charge Code |
900910321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC XYLOSE TOLERANCE BLD
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 84620
|
| Hospital Charge Code |
900910321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.23
|
| Rate for Payer: Blue Shield of California Commercial |
$25.36
|
| Rate for Payer: Blue Shield of California Commercial |
$108.33
|
| Rate for Payer: Blue Shield of California Commercial |
$38.34
|
| Rate for Payer: Blue Shield of California Commercial |
$163.79
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$150.40
|
| Rate for Payer: Cigna of CA PPO |
$173.90
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.30
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.46
|
| Rate for Payer: United Healthcare All Other HMO |
$10.46
|
| Rate for Payer: United Healthcare All Other HMO |
$10.46
|
| Rate for Payer: United Healthcare HMO Rider |
$10.46
|
| Rate for Payer: United Healthcare HMO Rider |
$10.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.91
|
| Rate for Payer: Vantage Medical Group Senior |
$12.91
|
|
|
HC Y90 MICROSPHERES
|
Facility
|
OP
|
$28,943.00
|
|
|
Service Code
|
CPT C2616
|
| Hospital Charge Code |
909301347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,788.60 |
| Max. Negotiated Rate |
$36,913.67 |
| Rate for Payer: Adventist Health Commercial |
$5,788.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,557.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,609.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,371.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,519.20
|
| Rate for Payer: Blue Shield of California Commercial |
$22,257.17
|
| Rate for Payer: Blue Shield of California Commercial |
$14,674.10
|
| Rate for Payer: Cash Price |
$13,024.35
|
| Rate for Payer: Cash Price |
$13,024.35
|
| Rate for Payer: Cigna of CA HMO |
$20,260.10
|
| Rate for Payer: Cigna of CA PPO |
$20,260.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,557.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,609.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,371.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,260.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,913.67
|
| Rate for Payer: EPIC Health Plan Senior |
$24,609.11
|
| Rate for Payer: Galaxy Health WC |
$24,601.55
|
| Rate for Payer: Global Benefits Group Commercial |
$17,365.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36,689.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,371.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,378.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,320.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,946.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,188.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,978.37
|
| Rate for Payer: Multiplan Commercial |
$23,154.40
|
| Rate for Payer: Networks By Design Commercial |
$14,471.50
|
| Rate for Payer: Prime Health Services Commercial |
$24,601.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,365.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,365.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,862.31
|
| Rate for Payer: United Healthcare All Other HMO |
$10,572.88
|
| Rate for Payer: United Healthcare HMO Rider |
$10,344.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,478.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,371.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,557.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,609.11
|
| Rate for Payer: Vantage Medical Group Senior |
$22,371.92
|
|
|
HC Y90 MICROSPHERES
|
Facility
|
IP
|
$28,943.00
|
|
|
Service Code
|
CPT C2616
|
| Hospital Charge Code |
909301347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,788.60 |
| Max. Negotiated Rate |
$24,601.55 |
| Rate for Payer: Adventist Health Commercial |
$5,788.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$13,024.35
|
| Rate for Payer: Cash Price |
$13,024.35
|
| Rate for Payer: Cigna of CA HMO |
$20,260.10
|
| Rate for Payer: Cigna of CA PPO |
$20,260.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,260.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,577.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,577.20
|
| Rate for Payer: Galaxy Health WC |
$24,601.55
|
| Rate for Payer: Global Benefits Group Commercial |
$17,365.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,378.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,076.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,946.32
|
| Rate for Payer: Multiplan Commercial |
$23,154.40
|
| Rate for Payer: Networks By Design Commercial |
$14,471.50
|
| Rate for Payer: Prime Health Services Commercial |
$24,601.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,862.31
|
| Rate for Payer: United Healthcare All Other HMO |
$10,572.88
|
| Rate for Payer: United Healthcare HMO Rider |
$10,344.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,478.83
|
|
|
HC Y-90 ZEVALIN UP TO 40 MCI
|
Facility
|
IP
|
$84,595.00
|
|
|
Service Code
|
CPT A9543
|
| Hospital Charge Code |
909301343
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$16,919.00 |
| Max. Negotiated Rate |
$71,905.75 |
| Rate for Payer: Adventist Health Commercial |
$16,919.00
|
| Rate for Payer: Blue Shield of California Commercial |
$42,889.67
|
| Rate for Payer: Blue Shield of California Commercial |
$65,053.56
|
| Rate for Payer: Cash Price |
$38,067.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59,216.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$33,838.00
|
| Rate for Payer: Galaxy Health WC |
$71,905.75
|
| Rate for Payer: Global Benefits Group Commercial |
$50,757.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53,717.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49,911.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,302.80
|
| Rate for Payer: Multiplan Commercial |
$67,676.00
|
| Rate for Payer: Networks By Design Commercial |
$54,986.75
|
| Rate for Payer: Prime Health Services Commercial |
$71,905.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,748.50
|
| Rate for Payer: United Healthcare All Other HMO |
$30,902.55
|
| Rate for Payer: United Healthcare HMO Rider |
$30,234.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27,704.86
|
|
|
HC Y-90 ZEVALIN UP TO 40 MCI
|
Facility
|
OP
|
$84,595.00
|
|
|
Service Code
|
CPT A9543
|
| Hospital Charge Code |
909301343
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$16,919.00 |
| Max. Negotiated Rate |
$462,581.52 |
| Rate for Payer: Adventist Health Commercial |
$16,919.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$462,581.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71,030.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62,507.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62,507.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141,987.31
|
| Rate for Payer: Blue Shield of California Commercial |
$35,614.50
|
| Rate for Payer: Blue Shield of California Commercial |
$53,971.61
|
| Rate for Payer: Cash Price |
$38,067.75
|
| Rate for Payer: Cash Price |
$38,067.75
|
| Rate for Payer: Cigna of CA HMO |
$54,140.80
|
| Rate for Payer: Cigna of CA PPO |
$62,600.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71,030.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$62,507.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62,507.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59,216.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$93,760.51
|
| Rate for Payer: EPIC Health Plan Senior |
$62,507.00
|
| Rate for Payer: Galaxy Health WC |
$71,905.75
|
| Rate for Payer: Global Benefits Group Commercial |
$50,757.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$93,192.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113,915.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,824.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53,717.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128,832.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79,554.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,302.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71,598.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,144.90
|
| Rate for Payer: Multiplan Commercial |
$67,676.00
|
| Rate for Payer: Networks By Design Commercial |
$54,986.75
|
| Rate for Payer: Prime Health Services Commercial |
$71,905.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50,757.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50,757.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,748.50
|
| Rate for Payer: United Healthcare All Other HMO |
$30,902.55
|
| Rate for Payer: United Healthcare HMO Rider |
$30,234.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27,704.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$56,824.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71,030.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62,507.00
|
| Rate for Payer: Vantage Medical Group Senior |
$62,507.00
|
|
|
HC YANKAUER BULB TIP ON/OFF CNTRL
|
Facility
|
IP
|
$7.38
|
|
| Hospital Charge Code |
901698562
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Senior |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.27
|
| Rate for Payer: Global Benefits Group Commercial |
$4.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Multiplan Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.27
|
|
|
HC YANKAUER BULB TIP ON/OFF CNTRL
|
Facility
|
OP
|
$7.38
|
|
| Hospital Charge Code |
901698562
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.74
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cigna of CA HMO |
$4.72
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Senior |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.27
|
| Rate for Payer: Global Benefits Group Commercial |
$4.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO |
$3.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Vantage Medical Group Senior |
$6.27
|
|
|
HC YANKAUER BULB TIP VENT
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
CPT A4628
|
| Hospital Charge Code |
901607940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.42
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$2.41
|
| Rate for Payer: Cigna of CA PPO |
$2.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3.20
|
|
|
HC YANKAUER BULB TIP VENT
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
CPT A4628
|
| Hospital Charge Code |
901607940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
|
|
HC YANKAUER FINE CAP FLANGE
|
Facility
|
IP
|
$4.59
|
|
| Hospital Charge Code |
901607936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
|
