|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.13 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$656.40
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna of CA PPO |
$809.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$820.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$807.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$807.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$875.20
|
| Rate for Payer: Networks By Design Commercial |
$711.10
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$89.13 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$656.40
|
| Rate for Payer: Blue Shield of California Commercial |
$806.28
|
| Rate for Payer: Blue Shield of California EPN |
$638.90
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna of CA HMO |
$700.16
|
| Rate for Payer: Cigna of CA PPO |
$809.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$820.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$807.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$807.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$875.20
|
| Rate for Payer: Networks By Design Commercial |
$711.10
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$262.56 |
| Max. Negotiated Rate |
$929.90 |
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.56
|
| Rate for Payer: Multiplan Commercial |
$875.20
|
| Rate for Payer: Networks By Design Commercial |
$711.10
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
IP
|
$2,069.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$496.56 |
| Max. Negotiated Rate |
$1,758.65 |
| Rate for Payer: Cash Price |
$931.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$827.60
|
| Rate for Payer: Galaxy Health WC |
$1,758.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,241.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.56
|
| Rate for Payer: Multiplan Commercial |
$1,655.20
|
| Rate for Payer: Networks By Design Commercial |
$1,344.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,758.65
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
OP
|
$2,069.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$248.29 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,241.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$931.05
|
| Rate for Payer: Cash Price |
$931.05
|
| Rate for Payer: Cigna of CA PPO |
$1,531.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,758.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,241.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,551.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,655.20
|
| Rate for Payer: Networks By Design Commercial |
$1,344.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,758.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,241.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
OP
|
$2,069.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.29 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,241.40
|
| Rate for Payer: Cash Price |
$931.05
|
| Rate for Payer: Cash Price |
$931.05
|
| Rate for Payer: Cash Price |
$931.05
|
| Rate for Payer: Cigna of CA PPO |
$1,531.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,758.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,241.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,551.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,655.20
|
| Rate for Payer: Networks By Design Commercial |
$1,344.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,758.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,241.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,034.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,034.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,034.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,034.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
IP
|
$2,069.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$496.56 |
| Max. Negotiated Rate |
$1,758.65 |
| Rate for Payer: Cash Price |
$931.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$827.60
|
| Rate for Payer: Galaxy Health WC |
$1,758.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,241.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.56
|
| Rate for Payer: Multiplan Commercial |
$1,655.20
|
| Rate for Payer: Networks By Design Commercial |
$1,344.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,758.65
|
|
|
HC PYRUVATE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$99.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$90.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.08
|
| Rate for Payer: Blue Distinction Transplant |
$24.60
|
| Rate for Payer: Blue Shield of California Commercial |
$26.49
|
| Rate for Payer: Blue Shield of California EPN |
$20.99
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Media |
$14.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.48
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.75
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.73
|
| Rate for Payer: United Healthcare All Other HMO |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
|
HC PYRUVATE CSF
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$99.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$90.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.08
|
| Rate for Payer: Blue Distinction Transplant |
$24.60
|
| Rate for Payer: Blue Shield of California Commercial |
$26.49
|
| Rate for Payer: Blue Shield of California EPN |
$20.99
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Media |
$14.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.48
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.75
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.73
|
| Rate for Payer: United Healthcare All Other HMO |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
|
HC RA223 DICLORIDE INJECTION PER MICRO CURIE
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
909301550
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$1,081.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,081.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$241.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$177.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$161.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.61
|
| Rate for Payer: Blue Distinction Transplant |
$357.00
|
| Rate for Payer: Blue Shield of California Commercial |
$351.64
|
| Rate for Payer: Blue Shield of California EPN |
$279.06
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cigna of CA HMO |
$380.80
|
| Rate for Payer: Cigna of CA PPO |
$440.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.74
|
| Rate for Payer: Dignity Health Media |
$161.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$177.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$161.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$161.16
|
| Rate for Payer: Galaxy Health WC |
$505.75
|
| Rate for Payer: Global Benefits Group Commercial |
$357.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$446.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.31
|
| Rate for Payer: Heritage Provider Network Transplant |
$264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$261.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$261.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$161.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$396.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$161.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$215.96
|
| Rate for Payer: Multiplan Commercial |
$476.00
|
| Rate for Payer: Networks By Design Commercial |
$386.75
|
| Rate for Payer: Prime Health Services Commercial |
$505.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$357.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$357.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other HMO |
$297.50
|
| Rate for Payer: United Healthcare HMO Rider |
$297.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$241.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$177.28
|
| Rate for Payer: Vantage Medical Group Senior |
$161.16
|
|
|
HC RA223 DICLORIDE INJECTION PER MICRO CURIE
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
909301550
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$505.75 |
| Rate for Payer: Blue Shield of California Commercial |
$423.64
|
| Rate for Payer: Blue Shield of California EPN |
$304.64
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.00
|
| Rate for Payer: Galaxy Health WC |
$505.75
|
| Rate for Payer: Global Benefits Group Commercial |
$357.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$396.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$476.00
|
| Rate for Payer: Networks By Design Commercial |
$386.75
|
| Rate for Payer: Prime Health Services Commercial |
$505.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$224.67
|
| Rate for Payer: United Healthcare All Other HMO |
$219.44
|
| Rate for Payer: United Healthcare HMO Rider |
$214.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.35
|
|
|
HC RADIATION TREATMENT DELIVERY INTERMEDIATE
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
909177407
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$73.66 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,626.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.49
|
| Rate for Payer: Blue Distinction Transplant |
$590.40
|
| Rate for Payer: Blue Shield of California Commercial |
$581.54
|
| Rate for Payer: Blue Shield of California EPN |
$461.50
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna of CA HMO |
$629.76
|
| Rate for Payer: Cigna of CA PPO |
$728.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.67
|
| Rate for Payer: Dignity Health Media |
$335.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.78
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$738.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$550.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$543.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$543.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.95
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.36
|
| Rate for Payer: Vantage Medical Group Senior |
$335.78
|
|
|
HC RADIATION TREATMENT DELIVERY INTERMEDIATE
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
909177407
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$236.16 |
| Max. Negotiated Rate |
$836.40 |
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$393.60
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
|
|
HC RADIATION TREATMENT DELIVERY SIMPLE
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
909177402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$198.48 |
| Max. Negotiated Rate |
$702.95 |
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$330.80
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.48
|
| Rate for Payer: Multiplan Commercial |
$661.60
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
|
|
HC RADIATION TREATMENT DELIVERY SIMPLE
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
909177402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$80.56 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,122.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$409.39
|
| Rate for Payer: Blue Distinction Transplant |
$496.20
|
| Rate for Payer: Blue Shield of California Commercial |
$488.76
|
| Rate for Payer: Blue Shield of California EPN |
$387.86
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cigna of CA HMO |
$529.28
|
| Rate for Payer: Cigna of CA PPO |
$611.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.73
|
| Rate for Payer: Dignity Health Media |
$149.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$149.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$149.82
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$620.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$245.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$242.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$242.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$149.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.76
|
| Rate for Payer: Multiplan Commercial |
$661.60
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$496.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Vantage Medical Group Senior |
$149.82
|
|
|
HC RADIATION TRT DEL COMPLEX
|
Facility
|
OP
|
$2,016.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
909100337
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$1,713.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,481.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$547.10
|
| Rate for Payer: Blue Distinction Transplant |
$1,209.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,191.46
|
| Rate for Payer: Blue Shield of California EPN |
$945.50
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cigna of CA HMO |
$1,290.24
|
| Rate for Payer: Cigna of CA PPO |
$1,491.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.67
|
| Rate for Payer: Dignity Health Media |
$335.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.78
|
| Rate for Payer: Galaxy Health WC |
$1,713.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,209.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,512.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$550.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$543.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$543.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,344.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$483.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.95
|
| Rate for Payer: Multiplan Commercial |
$1,612.80
|
| Rate for Payer: Networks By Design Commercial |
$1,310.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,713.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,209.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.36
|
| Rate for Payer: Vantage Medical Group Senior |
$335.78
|
|
|
HC RADIATION TRT DEL COMPLEX
|
Facility
|
IP
|
$2,016.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
909100337
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$483.84 |
| Max. Negotiated Rate |
$1,713.60 |
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$806.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$806.40
|
| Rate for Payer: Galaxy Health WC |
$1,713.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,209.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,344.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$483.84
|
| Rate for Payer: Multiplan Commercial |
$1,612.80
|
| Rate for Payer: Networks By Design Commercial |
$1,310.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,713.60
|
|
|
HC RADIOELEMENT HANDLING/LOADING
|
Facility
|
OP
|
$1,709.00
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
909100409
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$1,452.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$245.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,452.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$939.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$939.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.70
|
| Rate for Payer: Blue Distinction Transplant |
$1,025.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,010.02
|
| Rate for Payer: Blue Shield of California EPN |
$801.52
|
| Rate for Payer: Cash Price |
$769.05
|
| Rate for Payer: Cash Price |
$769.05
|
| Rate for Payer: Cigna of CA HMO |
$1,093.76
|
| Rate for Payer: Cigna of CA PPO |
$1,264.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,452.65
|
| Rate for Payer: Dignity Health Media |
$1,452.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,452.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$683.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$683.60
|
| Rate for Payer: Galaxy Health WC |
$1,452.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,025.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,281.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,139.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.16
|
| Rate for Payer: Multiplan Commercial |
$1,367.20
|
| Rate for Payer: Networks By Design Commercial |
$1,110.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,452.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,025.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,025.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$854.50
|
| Rate for Payer: United Healthcare All Other HMO |
$854.50
|
| Rate for Payer: United Healthcare HMO Rider |
$854.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$854.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,452.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,452.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,452.65
|
|
|
HC RADIOELEMENT HANDLING/LOADING
|
Facility
|
IP
|
$1,709.00
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
909100409
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$410.16 |
| Max. Negotiated Rate |
$1,452.65 |
| Rate for Payer: Cash Price |
$769.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$683.60
|
| Rate for Payer: Galaxy Health WC |
$1,452.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,025.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,139.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$651.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.16
|
| Rate for Payer: Multiplan Commercial |
$1,367.20
|
| Rate for Payer: Networks By Design Commercial |
$1,110.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,452.65
|
|
|
HC RADIOPHARM THERAPY IA ADMIN
|
Facility
|
IP
|
$5,904.00
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
909020038
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,416.96 |
| Max. Negotiated Rate |
$5,018.40 |
| Rate for Payer: Cash Price |
$2,656.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,361.60
|
| Rate for Payer: Galaxy Health WC |
$5,018.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,542.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,937.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,249.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.96
|
| Rate for Payer: Multiplan Commercial |
$4,723.20
|
| Rate for Payer: Networks By Design Commercial |
$3,837.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,018.40
|
|
|
HC RADIOPHARM THERAPY IA ADMIN
|
Facility
|
OP
|
$5,904.00
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
909020038
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$310.84 |
| Max. Negotiated Rate |
$5,018.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$613.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,517.60
|
| Rate for Payer: Blue Distinction Transplant |
$3,542.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,489.26
|
| Rate for Payer: Blue Shield of California EPN |
$2,768.98
|
| Rate for Payer: Cash Price |
$2,656.80
|
| Rate for Payer: Cash Price |
$2,656.80
|
| Rate for Payer: Cigna of CA HMO |
$3,778.56
|
| Rate for Payer: Cigna of CA PPO |
$4,368.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.26
|
| Rate for Payer: Dignity Health Media |
$310.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$310.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.84
|
| Rate for Payer: Galaxy Health WC |
$5,018.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,542.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,428.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.78
|
| Rate for Payer: Heritage Provider Network Transplant |
$509.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$503.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$503.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$310.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,937.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$391.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$416.53
|
| Rate for Payer: Multiplan Commercial |
$4,723.20
|
| Rate for Payer: Networks By Design Commercial |
$3,837.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,018.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,542.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,542.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$589.62
|
| Rate for Payer: United Healthcare All Other HMO |
$589.62
|
| Rate for Payer: United Healthcare HMO Rider |
$589.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Vantage Medical Group Senior |
$310.84
|
|
|
HC RADIOPHARM THERAPY INTRACAVITARY ADMIN
|
Facility
|
OP
|
$1,378.00
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
909301456
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$197.28 |
| Max. Negotiated Rate |
$1,171.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$429.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$821.01
|
| Rate for Payer: Blue Distinction Transplant |
$826.80
|
| Rate for Payer: Blue Shield of California Commercial |
$814.40
|
| Rate for Payer: Blue Shield of California EPN |
$646.28
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Cigna of CA HMO |
$881.92
|
| Rate for Payer: Cigna of CA PPO |
$1,019.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.26
|
| Rate for Payer: Dignity Health Media |
$310.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$310.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.84
|
| Rate for Payer: Galaxy Health WC |
$1,171.30
|
| Rate for Payer: Global Benefits Group Commercial |
$826.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,033.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.78
|
| Rate for Payer: Heritage Provider Network Transplant |
$509.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$503.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$503.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$310.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$391.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$416.53
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: Networks By Design Commercial |
$895.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,171.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$826.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$826.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$742.99
|
| Rate for Payer: United Healthcare All Other HMO |
$742.99
|
| Rate for Payer: United Healthcare HMO Rider |
$742.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$742.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Vantage Medical Group Senior |
$310.84
|
|
|
HC RADIOPHARM THERAPY INTRACAVITARY ADMIN
|
Facility
|
IP
|
$1,378.00
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
909301456
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$330.72 |
| Max. Negotiated Rate |
$1,171.30 |
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.20
|
| Rate for Payer: Galaxy Health WC |
$1,171.30
|
| Rate for Payer: Global Benefits Group Commercial |
$826.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.72
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: Networks By Design Commercial |
$895.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,171.30
|
|
|
HC RADIOPHARM THERAPY INTRAVENOUS ADMIN
|
Facility
|
OP
|
$3,258.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301455
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$239.67 |
| Max. Negotiated Rate |
$2,769.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$377.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,941.12
|
| Rate for Payer: Blue Distinction Transplant |
$1,954.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,925.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,528.00
|
| Rate for Payer: Cash Price |
$1,466.10
|
| Rate for Payer: Cash Price |
$1,466.10
|
| Rate for Payer: Cigna of CA HMO |
$2,085.12
|
| Rate for Payer: Cigna of CA PPO |
$2,410.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.26
|
| Rate for Payer: Dignity Health Media |
$310.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$310.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.84
|
| Rate for Payer: Galaxy Health WC |
$2,769.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,954.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,443.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.78
|
| Rate for Payer: Heritage Provider Network Transplant |
$509.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$503.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$503.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$310.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,173.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$781.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$391.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$416.53
|
| Rate for Payer: Multiplan Commercial |
$2,606.40
|
| Rate for Payer: Networks By Design Commercial |
$2,117.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,769.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,954.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,954.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$589.62
|
| Rate for Payer: United Healthcare All Other HMO |
$589.62
|
| Rate for Payer: United Healthcare HMO Rider |
$589.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Vantage Medical Group Senior |
$310.84
|
|
|
HC RADIOPHARM THERAPY INTRAVENOUS ADMIN
|
Facility
|
IP
|
$3,258.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301455
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$781.92 |
| Max. Negotiated Rate |
$2,769.30 |
| Rate for Payer: Cash Price |
$1,466.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,303.20
|
| Rate for Payer: Galaxy Health WC |
$2,769.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,954.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,173.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,241.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$781.92
|
| Rate for Payer: Multiplan Commercial |
$2,606.40
|
| Rate for Payer: Networks By Design Commercial |
$2,117.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,769.30
|
|
