|
HC IMPLANT INSERTION NON-BIODEG
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
950510099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$327.25 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$269.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Senior |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
|
|
HC IMPLANT INSERTION NON-BIODEG
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
950510099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.06 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$247.05
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA HMO |
$246.40
|
| Rate for Payer: Cigna of CA PPO |
$284.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$269.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC IMPLANT REMOVAL NON-BIODEG
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
950510101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$882.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$504.00
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$800.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$743.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
|
|
HC IMPLANT REMOVAL NON-BIODEG
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
950510101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$882.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$504.00
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$800.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$743.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
|
|
HC IMPLANT REMOVAL NON-BIODEG
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
950510101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$188.88 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$611.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$808.54
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna of CA HMO |
$806.40
|
| Rate for Payer: Cigna of CA PPO |
$932.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$882.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$800.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$213.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$804.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$756.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$756.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$630.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$630.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC IMPLANT REMOVAL NON-BIODEG
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
950510101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.88 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$808.54
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna of CA HMO |
$806.40
|
| Rate for Payer: Cigna of CA PPO |
$932.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$882.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$800.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$213.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$804.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC IMPLANT REMOVE & REINSERTION
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
950510103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$882.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$504.00
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$800.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$743.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
|
|
HC IMPLANT REMOVE & REINSERTION
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
950510103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$808.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna of CA HMO |
$806.40
|
| Rate for Payer: Cigna of CA PPO |
$932.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$882.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$304.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$800.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$344.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$804.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC IMPL SJM CONFIRM LOOPRE DM3500
|
Facility
|
OP
|
$11,500.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
906813826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.00 |
| Max. Negotiated Rate |
$9,775.00 |
| Rate for Payer: Adventist Health Commercial |
$2,300.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,775.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,325.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,625.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,960.95
|
| Rate for Payer: Blue Shield of California Commercial |
$5,830.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,843.50
|
| Rate for Payer: Cash Price |
$5,175.00
|
| Rate for Payer: Cigna of CA HMO |
$8,050.00
|
| Rate for Payer: Cigna of CA PPO |
$8,050.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,775.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,775.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,775.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,600.00
|
| Rate for Payer: Galaxy Health WC |
$9,775.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,900.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,302.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,174.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,785.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,760.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,050.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,050.00
|
| Rate for Payer: Multiplan Commercial |
$9,200.00
|
| Rate for Payer: Networks By Design Commercial |
$5,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,775.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,900.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,900.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,315.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4,200.95
|
| Rate for Payer: United Healthcare HMO Rider |
$4,110.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,766.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,775.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,775.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,775.00
|
|
|
HC IMPL SJM CONFIRM LOOPRE DM3500
|
Facility
|
IP
|
$11,500.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
906813826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,175.00
|
| Rate for Payer: Cash Price |
$5,175.00
|
| Rate for Payer: Cigna of CA HMO |
$8,050.00
|
| Rate for Payer: Cigna of CA PPO |
$8,050.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,600.00
|
| Rate for Payer: Galaxy Health WC |
$9,775.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,900.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,302.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,785.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,760.00
|
| Rate for Payer: Multiplan Commercial |
$9,200.00
|
| Rate for Payer: Networks By Design Commercial |
$5,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,775.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,315.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4,200.95
|
| Rate for Payer: United Healthcare HMO Rider |
$4,110.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,766.25
|
|
|
HC IMPL SPINAL CANAL CATH
|
Facility
|
IP
|
$16,527.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
900100865
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,305.40 |
| Max. Negotiated Rate |
$14,047.95 |
| Rate for Payer: Adventist Health Commercial |
$3,305.40
|
| Rate for Payer: Cash Price |
$7,437.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,568.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,610.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,610.80
|
| Rate for Payer: Galaxy Health WC |
$14,047.95
|
| Rate for Payer: Global Benefits Group Commercial |
$9,916.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,494.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,750.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,966.48
|
| Rate for Payer: Multiplan Commercial |
$13,221.60
|
| Rate for Payer: Networks By Design Commercial |
$10,742.55
|
| Rate for Payer: Prime Health Services Commercial |
$14,047.95
|
|
|
HC IMPL SPINAL CANAL CATH
|
Facility
|
OP
|
$16,527.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
900100865
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$438.45 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,305.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,287.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$7,437.15
|
| Rate for Payer: Cash Price |
$7,437.15
|
| Rate for Payer: Cash Price |
$7,437.15
|
| Rate for Payer: Cigna of CA HMO |
$10,577.28
|
| Rate for Payer: Cigna of CA PPO |
$12,229.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,415.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,287.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,568.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,623.90
|
| Rate for Payer: EPIC Health Plan Senior |
$12,415.93
|
| Rate for Payer: Galaxy Health WC |
$14,047.95
|
| Rate for Payer: Global Benefits Group Commercial |
$9,916.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18,511.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$438.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,287.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,494.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$495.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,802.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,966.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,221.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,124.86
|
| Rate for Payer: Multiplan Commercial |
$13,221.60
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: Networks By Design Commercial |
$10,742.55
|
| Rate for Payer: Prime Health Services Commercial |
$14,047.95
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,916.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,263.50
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$11,287.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Vantage Medical Group Senior |
$11,287.21
|
|
|
HC IMRT TREATMENT DELIVERY COMPLEX
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
909177386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$337.60 |
| Max. Negotiated Rate |
$4,920.86 |
| Rate for Payer: Adventist Health Commercial |
$337.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,742.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,434.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$928.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,266.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,920.86
|
| Rate for Payer: Blue Shield of California Commercial |
$710.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,076.94
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna of CA HMO |
$1,080.32
|
| Rate for Payer: Cigna of CA PPO |
$1,249.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,434.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,434.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,434.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,181.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$675.20
|
| Rate for Payer: EPIC Health Plan Senior |
$675.20
|
| Rate for Payer: Galaxy Health WC |
$1,434.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,071.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$612.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$995.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,181.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,181.60
|
| Rate for Payer: Multiplan Commercial |
$1,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,097.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,434.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,012.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,434.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,434.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,434.80
|
|
|
HC IMRT TREATMENT DELIVERY COMPLEX
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
909177386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$337.60 |
| Max. Negotiated Rate |
$1,434.80 |
| Rate for Payer: Adventist Health Commercial |
$337.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,181.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$675.20
|
| Rate for Payer: EPIC Health Plan Senior |
$675.20
|
| Rate for Payer: Galaxy Health WC |
$1,434.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,071.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$995.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.12
|
| Rate for Payer: Multiplan Commercial |
$1,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,097.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,434.80
|
|
|
HC IMRT TREATMENT DELIVERY SIMPLE
|
Facility
|
OP
|
$1,603.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
909177385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$320.60 |
| Max. Negotiated Rate |
$4,099.92 |
| Rate for Payer: Adventist Health Commercial |
$320.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,737.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,362.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$881.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,202.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,099.92
|
| Rate for Payer: Blue Shield of California Commercial |
$674.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,022.71
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Cigna of CA HMO |
$1,025.92
|
| Rate for Payer: Cigna of CA PPO |
$1,186.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,362.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,362.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,362.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,122.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$641.20
|
| Rate for Payer: EPIC Health Plan Senior |
$641.20
|
| Rate for Payer: Galaxy Health WC |
$1,362.55
|
| Rate for Payer: Global Benefits Group Commercial |
$961.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,017.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$581.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$945.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,122.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,122.10
|
| Rate for Payer: Multiplan Commercial |
$1,282.40
|
| Rate for Payer: Networks By Design Commercial |
$1,041.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,362.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$961.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,362.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,362.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,362.55
|
|
|
HC IMRT TREATMENT DELIVERY SIMPLE
|
Facility
|
IP
|
$1,603.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
909177385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$320.60 |
| Max. Negotiated Rate |
$1,362.55 |
| Rate for Payer: Adventist Health Commercial |
$320.60
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,122.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$641.20
|
| Rate for Payer: EPIC Health Plan Senior |
$641.20
|
| Rate for Payer: Galaxy Health WC |
$1,362.55
|
| Rate for Payer: Global Benefits Group Commercial |
$961.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,017.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$945.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Multiplan Commercial |
$1,282.40
|
| Rate for Payer: Networks By Design Commercial |
$1,041.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,362.55
|
|
|
HC IN111 PENTETRTID/OCTRE/LT 6MCI
|
Facility
|
OP
|
$19,095.00
|
|
|
Service Code
|
CPT A9572
|
| Hospital Charge Code |
909301570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,000.94 |
| Max. Negotiated Rate |
$23,012.94 |
| Rate for Payer: Adventist Health Commercial |
$3,819.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,501.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,201.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,012.94
|
| Rate for Payer: Cash Price |
$8,592.75
|
| Rate for Payer: Cash Price |
$8,592.75
|
| Rate for Payer: Cigna of CA HMO |
$13,366.50
|
| Rate for Payer: Cigna of CA PPO |
$13,366.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,501.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,201.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,366.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,301.55
|
| Rate for Payer: EPIC Health Plan Senior |
$2,201.03
|
| Rate for Payer: Galaxy Health WC |
$16,230.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11,457.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,000.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,125.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,801.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,582.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.26
|
| Rate for Payer: Multiplan Commercial |
$15,276.00
|
| Rate for Payer: Networks By Design Commercial |
$9,547.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,230.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,457.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,457.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,166.35
|
| Rate for Payer: United Healthcare All Other HMO |
$6,975.40
|
| Rate for Payer: United Healthcare HMO Rider |
$6,824.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,253.61
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,000.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,501.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.03
|
| Rate for Payer: Vantage Medical Group Senior |
$2,201.03
|
|
|
HC IN111 PENTETRTID/OCTRE/LT 6MCI
|
Facility
|
IP
|
$19,095.00
|
|
|
Service Code
|
CPT A9572
|
| Hospital Charge Code |
909301570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,819.00 |
| Max. Negotiated Rate |
$16,230.75 |
| Rate for Payer: Adventist Health Commercial |
$3,819.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,684.06
|
| Rate for Payer: Blue Shield of California Commercial |
$9,681.17
|
| Rate for Payer: Cash Price |
$8,592.75
|
| Rate for Payer: Cigna of CA HMO |
$13,366.50
|
| Rate for Payer: Cigna of CA PPO |
$13,366.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,366.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,638.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,638.00
|
| Rate for Payer: Galaxy Health WC |
$16,230.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11,457.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,125.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,266.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,582.80
|
| Rate for Payer: Multiplan Commercial |
$15,276.00
|
| Rate for Payer: Networks By Design Commercial |
$9,547.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,230.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,166.35
|
| Rate for Payer: United Healthcare All Other HMO |
$6,975.40
|
| Rate for Payer: United Healthcare HMO Rider |
$6,824.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,253.61
|
|
|
HC IN111 PROSTASCINT UP TO 10 MCI
|
Facility
|
OP
|
$8,469.00
|
|
|
Service Code
|
CPT A9507
|
| Hospital Charge Code |
909301255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,693.80 |
| Max. Negotiated Rate |
$7,198.65 |
| Rate for Payer: Adventist Health Commercial |
$1,693.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,595.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,903.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,730.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,912.76
|
| Rate for Payer: Cash Price |
$3,811.05
|
| Rate for Payer: Cash Price |
$3,811.05
|
| Rate for Payer: Cigna of CA HMO |
$5,928.30
|
| Rate for Payer: Cigna of CA PPO |
$5,928.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,903.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,730.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,928.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,854.98
|
| Rate for Payer: EPIC Health Plan Senior |
$1,903.32
|
| Rate for Payer: Galaxy Health WC |
$7,198.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,081.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,837.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,783.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,730.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,377.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,279.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,422.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,032.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,180.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,318.59
|
| Rate for Payer: Multiplan Commercial |
$6,775.20
|
| Rate for Payer: Networks By Design Commercial |
$4,234.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,198.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,081.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,081.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,178.42
|
| Rate for Payer: United Healthcare All Other HMO |
$3,093.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3,026.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,773.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,730.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,595.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,903.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,730.29
|
|
|
HC IN111 PROSTASCINT UP TO 10 MCI
|
Facility
|
IP
|
$8,469.00
|
|
|
Service Code
|
CPT A9507
|
| Hospital Charge Code |
909301255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,693.80 |
| Max. Negotiated Rate |
$7,198.65 |
| Rate for Payer: Adventist Health Commercial |
$1,693.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,293.78
|
| Rate for Payer: Blue Shield of California Commercial |
$6,512.66
|
| Rate for Payer: Cash Price |
$3,811.05
|
| Rate for Payer: Cigna of CA HMO |
$5,928.30
|
| Rate for Payer: Cigna of CA PPO |
$5,928.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,928.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,387.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,387.60
|
| Rate for Payer: Galaxy Health WC |
$7,198.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,081.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,377.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,996.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,032.56
|
| Rate for Payer: Multiplan Commercial |
$6,775.20
|
| Rate for Payer: Networks By Design Commercial |
$4,234.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,198.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,178.42
|
| Rate for Payer: United Healthcare All Other HMO |
$3,093.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3,026.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,773.60
|
|
|
HC IN111 ZEVALIN UP TO 5 MCI
|
Facility
|
IP
|
$14,213.00
|
|
|
Service Code
|
CPT A9542
|
| Hospital Charge Code |
909301342
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,842.60 |
| Max. Negotiated Rate |
$12,081.05 |
| Rate for Payer: Adventist Health Commercial |
$2,842.60
|
| Rate for Payer: Cash Price |
$6,395.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,949.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,685.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,685.20
|
| Rate for Payer: Galaxy Health WC |
$12,081.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,527.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,025.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,385.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,411.12
|
| Rate for Payer: Multiplan Commercial |
$11,370.40
|
| Rate for Payer: Networks By Design Commercial |
$9,238.45
|
| Rate for Payer: Prime Health Services Commercial |
$12,081.05
|
|
|
HC IN111 ZEVALIN UP TO 5 MCI
|
Facility
|
OP
|
$14,213.00
|
|
|
Service Code
|
CPT A9542
|
| Hospital Charge Code |
909301342
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,842.60 |
| Max. Negotiated Rate |
$12,081.05 |
| Rate for Payer: Adventist Health Commercial |
$2,842.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,081.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,817.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,659.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,551.84
|
| Rate for Payer: Blue Shield of California Commercial |
$9,067.89
|
| Rate for Payer: Blue Shield of California Commercial |
$5,983.67
|
| Rate for Payer: Cash Price |
$6,395.85
|
| Rate for Payer: Cash Price |
$6,395.85
|
| Rate for Payer: Cigna of CA HMO |
$9,096.32
|
| Rate for Payer: Cigna of CA PPO |
$10,517.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,081.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,081.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,081.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,949.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,685.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,685.20
|
| Rate for Payer: Galaxy Health WC |
$12,081.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,527.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,863.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,025.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,631.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,385.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,411.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,949.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,949.10
|
| Rate for Payer: Multiplan Commercial |
$11,370.40
|
| Rate for Payer: Networks By Design Commercial |
$9,238.45
|
| Rate for Payer: Prime Health Services Commercial |
$12,081.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,527.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,527.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,106.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,106.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,106.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,106.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,081.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,081.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12,081.05
|
|
|
HC INACT POLIO ADMINISTRATION
|
Facility
|
IP
|
$39.00
|
|
| Hospital Charge Code |
908603015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
HC INACT POLIO ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890241
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC INACT POLIO ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890241
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
