|
HC RADIATION TREATMENT DELIVERY INTERMEDIATE
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
909177407
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$674.90 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Cash Price |
$436.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.60
|
| Rate for Payer: EPIC Health Plan Senior |
$317.60
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$529.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$491.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
|
|
HC RADIATION TREATMENT DELIVERY SIMPLE
|
Facility
|
OP
|
$667.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
909177402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$71.23 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$133.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$437.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$208.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$443.20
|
| Rate for Payer: Blue Shield of California Commercial |
$408.20
|
| Rate for Payer: Blue Shield of California EPN |
$269.47
|
| Rate for Payer: Cash Price |
$366.85
|
| Rate for Payer: Cash Price |
$366.85
|
| Rate for Payer: Cash Price |
$366.85
|
| Rate for Payer: Cigna of CA HMO |
$426.88
|
| Rate for Payer: Cigna of CA PPO |
$493.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$208.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$139.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.83
|
| Rate for Payer: EPIC Health Plan Senior |
$139.13
|
| Rate for Payer: Galaxy Health WC |
$566.95
|
| Rate for Payer: Global Benefits Group Commercial |
$400.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$228.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$139.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.43
|
| Rate for Payer: Multiplan Commercial |
$533.60
|
| Rate for Payer: Networks By Design Commercial |
$433.55
|
| Rate for Payer: Prime Health Services Commercial |
$566.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.20
|
| 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: Upland Medical Group Pediatric |
$139.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$208.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.04
|
| Rate for Payer: Vantage Medical Group Senior |
$139.13
|
|
|
HC RADIATION TREATMENT DELIVERY SIMPLE
|
Facility
|
IP
|
$667.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
909177402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$566.95 |
| Rate for Payer: Adventist Health Commercial |
$133.40
|
| Rate for Payer: Cash Price |
$366.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.80
|
| Rate for Payer: EPIC Health Plan Senior |
$266.80
|
| Rate for Payer: Galaxy Health WC |
$566.95
|
| Rate for Payer: Global Benefits Group Commercial |
$400.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$412.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.08
|
| Rate for Payer: Multiplan Commercial |
$533.60
|
| Rate for Payer: Networks By Design Commercial |
$433.55
|
| Rate for Payer: Prime Health Services Commercial |
$566.95
|
|
|
HC RADIATION TRT DEL COMPLEX
|
Facility
|
OP
|
$1,628.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
909100337
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,067.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$501.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$334.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$592.29
|
| Rate for Payer: Blue Shield of California Commercial |
$996.34
|
| Rate for Payer: Blue Shield of California EPN |
$657.71
|
| Rate for Payer: Cash Price |
$895.40
|
| Rate for Payer: Cash Price |
$895.40
|
| Rate for Payer: Cash Price |
$895.40
|
| Rate for Payer: Cigna of CA HMO |
$1,041.92
|
| Rate for Payer: Cigna of CA PPO |
$1,204.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$501.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$334.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.09
|
| Rate for Payer: EPIC Health Plan Senior |
$334.14
|
| Rate for Payer: Galaxy Health WC |
$1,383.80
|
| Rate for Payer: Global Benefits Group Commercial |
$976.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$547.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$334.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,085.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$421.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$447.75
|
| Rate for Payer: Multiplan Commercial |
$1,302.40
|
| Rate for Payer: Networks By Design Commercial |
$1,058.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,383.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$976.80
|
| 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: Upland Medical Group Pediatric |
$334.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$501.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.55
|
| Rate for Payer: Vantage Medical Group Senior |
$334.14
|
|
|
HC RADIATION TRT DEL COMPLEX
|
Facility
|
IP
|
$1,628.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
909100337
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$325.60 |
| Max. Negotiated Rate |
$1,383.80 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Cash Price |
$895.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.20
|
| Rate for Payer: EPIC Health Plan Senior |
$651.20
|
| Rate for Payer: Galaxy Health WC |
$1,383.80
|
| Rate for Payer: Global Benefits Group Commercial |
$976.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,085.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$620.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,007.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.72
|
| Rate for Payer: Multiplan Commercial |
$1,302.40
|
| Rate for Payer: Networks By Design Commercial |
$1,058.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,383.80
|
|
|
HC RADIOELEMENT HANDLING/LOADING
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
909100409
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Adventist Health Commercial |
$276.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$905.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$759.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,035.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.83
|
| Rate for Payer: Blue Shield of California Commercial |
$844.56
|
| Rate for Payer: Blue Shield of California EPN |
$557.52
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna of CA HMO |
$883.20
|
| Rate for Payer: Cigna of CA PPO |
$1,021.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,173.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,173.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.00
|
| Rate for Payer: EPIC Health Plan Senior |
$552.00
|
| Rate for Payer: Galaxy Health WC |
$1,173.00
|
| Rate for Payer: Global Benefits Group Commercial |
$828.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$920.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$854.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$966.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$966.00
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: Networks By Design Commercial |
$897.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$828.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$828.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$690.00
|
| Rate for Payer: United Healthcare All Other HMO |
$690.00
|
| Rate for Payer: United Healthcare HMO Rider |
$690.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$690.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,173.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,173.00
|
|
|
HC RADIOELEMENT HANDLING/LOADING
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
909100409
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Adventist Health Commercial |
$276.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.00
|
| Rate for Payer: EPIC Health Plan Senior |
$552.00
|
| Rate for Payer: Galaxy Health WC |
$1,173.00
|
| Rate for Payer: Global Benefits Group Commercial |
$828.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$920.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$854.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.20
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: Networks By Design Commercial |
$897.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.00
|
|
|
HC RADIOPHARM THERAPY IA ADMIN
|
Facility
|
IP
|
$5,018.00
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
909020038
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,003.60 |
| Max. Negotiated Rate |
$4,265.30 |
| Rate for Payer: Adventist Health Commercial |
$1,003.60
|
| Rate for Payer: Cash Price |
$2,759.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,007.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,007.20
|
| Rate for Payer: Galaxy Health WC |
$4,265.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,010.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,347.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,106.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.32
|
| Rate for Payer: Multiplan Commercial |
$4,014.40
|
| Rate for Payer: Networks By Design Commercial |
$3,261.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,265.30
|
|
|
HC RADIOPHARM THERAPY IA ADMIN
|
Facility
|
OP
|
$5,018.00
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
909020038
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$284.78 |
| Max. Negotiated Rate |
$4,265.30 |
| Rate for Payer: Adventist Health Commercial |
$1,003.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,291.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,081.55
|
| Rate for Payer: Blue Shield of California Commercial |
$3,071.02
|
| Rate for Payer: Blue Shield of California EPN |
$2,027.27
|
| Rate for Payer: Cash Price |
$2,759.90
|
| Rate for Payer: Cash Price |
$2,759.90
|
| Rate for Payer: Cigna of CA HMO |
$3,211.52
|
| Rate for Payer: Cigna of CA PPO |
$3,713.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$313.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$284.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.45
|
| Rate for Payer: EPIC Health Plan Senior |
$284.78
|
| Rate for Payer: Galaxy Health WC |
$4,265.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,010.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$467.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$336.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$284.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,347.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$381.61
|
| Rate for Payer: Multiplan Commercial |
$4,014.40
|
| Rate for Payer: Networks By Design Commercial |
$3,261.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,265.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,010.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,010.80
|
| 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: Upland Medical Group Pediatric |
$284.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Vantage Medical Group Senior |
$284.78
|
|
|
HC RADIOPHARM THERAPY INTRACAVITARY ADMIN
|
Facility
|
IP
|
$1,171.00
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
909301456
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$234.20 |
| Max. Negotiated Rate |
$995.35 |
| Rate for Payer: Adventist Health Commercial |
$234.20
|
| Rate for Payer: Cash Price |
$644.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.40
|
| Rate for Payer: EPIC Health Plan Senior |
$468.40
|
| Rate for Payer: Galaxy Health WC |
$995.35
|
| Rate for Payer: Global Benefits Group Commercial |
$702.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$724.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.04
|
| Rate for Payer: Multiplan Commercial |
$936.80
|
| Rate for Payer: Networks By Design Commercial |
$761.15
|
| Rate for Payer: Prime Health Services Commercial |
$995.35
|
|
|
HC RADIOPHARM THERAPY INTRACAVITARY ADMIN
|
Facility
|
OP
|
$1,171.00
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
909301456
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$174.43 |
| Max. Negotiated Rate |
$995.35 |
| Rate for Payer: Adventist Health Commercial |
$234.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$768.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$719.11
|
| Rate for Payer: Blue Shield of California Commercial |
$716.65
|
| Rate for Payer: Blue Shield of California EPN |
$473.08
|
| Rate for Payer: Cash Price |
$644.05
|
| Rate for Payer: Cash Price |
$644.05
|
| Rate for Payer: Cigna of CA HMO |
$749.44
|
| Rate for Payer: Cigna of CA PPO |
$866.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$313.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$284.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.45
|
| Rate for Payer: EPIC Health Plan Senior |
$284.78
|
| Rate for Payer: Galaxy Health WC |
$995.35
|
| Rate for Payer: Global Benefits Group Commercial |
$702.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$467.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$284.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$381.61
|
| Rate for Payer: Multiplan Commercial |
$936.80
|
| Rate for Payer: Networks By Design Commercial |
$761.15
|
| Rate for Payer: Prime Health Services Commercial |
$995.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$702.60
|
| 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: Upland Medical Group Pediatric |
$284.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Vantage Medical Group Senior |
$284.78
|
|
|
HC RADIOPHARM THERAPY INTRAVENOUS ADMIN
|
Facility
|
IP
|
$2,769.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301455
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$553.80 |
| Max. Negotiated Rate |
$2,353.65 |
| Rate for Payer: Adventist Health Commercial |
$553.80
|
| Rate for Payer: Cash Price |
$1,522.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,107.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,107.60
|
| Rate for Payer: Galaxy Health WC |
$2,353.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,661.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,846.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,054.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,714.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.56
|
| Rate for Payer: Multiplan Commercial |
$2,215.20
|
| Rate for Payer: Networks By Design Commercial |
$1,799.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,353.65
|
|
|
HC RADIOPHARM THERAPY INTRAVENOUS ADMIN
|
Facility
|
OP
|
$2,769.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301455
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$211.92 |
| Max. Negotiated Rate |
$2,353.65 |
| Rate for Payer: Adventist Health Commercial |
$553.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,816.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,700.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,694.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.68
|
| Rate for Payer: Cash Price |
$1,522.95
|
| Rate for Payer: Cash Price |
$1,522.95
|
| Rate for Payer: Cigna of CA HMO |
$1,772.16
|
| Rate for Payer: Cigna of CA PPO |
$2,049.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$313.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$284.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.45
|
| Rate for Payer: EPIC Health Plan Senior |
$284.78
|
| Rate for Payer: Galaxy Health WC |
$2,353.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,661.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$467.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$284.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,846.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$381.61
|
| Rate for Payer: Multiplan Commercial |
$2,215.20
|
| Rate for Payer: Networks By Design Commercial |
$1,799.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,353.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,661.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,661.40
|
| 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: Upland Medical Group Pediatric |
$284.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Vantage Medical Group Senior |
$284.78
|
|
|
HC RADIOPHARM THERAPY ORAL ADMIN
|
Facility
|
IP
|
$2,422.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
909301454
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$484.40 |
| Max. Negotiated Rate |
$2,058.70 |
| Rate for Payer: Adventist Health Commercial |
$484.40
|
| Rate for Payer: Cash Price |
$1,332.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$968.80
|
| Rate for Payer: EPIC Health Plan Senior |
$968.80
|
| Rate for Payer: Galaxy Health WC |
$2,058.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,453.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,615.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$922.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,499.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.28
|
| Rate for Payer: Multiplan Commercial |
$1,937.60
|
| Rate for Payer: Networks By Design Commercial |
$1,574.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,058.70
|
|
|
HC RADIOPHARM THERAPY ORAL ADMIN
|
Facility
|
OP
|
$2,422.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
909301454
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$200.10 |
| Max. Negotiated Rate |
$2,058.70 |
| Rate for Payer: Adventist Health Commercial |
$484.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,588.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$723.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,482.26
|
| Rate for Payer: Blue Shield of California EPN |
$978.49
|
| Rate for Payer: Cash Price |
$1,332.10
|
| Rate for Payer: Cash Price |
$1,332.10
|
| Rate for Payer: Cigna of CA HMO |
$1,550.08
|
| Rate for Payer: Cigna of CA PPO |
$1,792.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$313.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$284.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.45
|
| Rate for Payer: EPIC Health Plan Senior |
$284.78
|
| Rate for Payer: Galaxy Health WC |
$2,058.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,453.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$467.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$200.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$284.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,615.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$381.61
|
| Rate for Payer: Multiplan Commercial |
$1,937.60
|
| Rate for Payer: Networks By Design Commercial |
$1,574.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,058.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,453.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,453.20
|
| 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: Upland Medical Group Pediatric |
$284.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Vantage Medical Group Senior |
$284.78
|
|
|
HC RADIOPHARM THERAPY Y-90 ZEVALIN
|
Facility
|
OP
|
$4,360.00
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
909301344
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$239.00 |
| Max. Negotiated Rate |
$3,706.00 |
| Rate for Payer: Adventist Health Commercial |
$872.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,859.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,677.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,668.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,761.44
|
| Rate for Payer: Cash Price |
$2,398.00
|
| Rate for Payer: Cash Price |
$2,398.00
|
| Rate for Payer: Cigna of CA HMO |
$2,790.40
|
| Rate for Payer: Cigna of CA PPO |
$3,226.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$313.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$284.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.45
|
| Rate for Payer: EPIC Health Plan Senior |
$284.78
|
| Rate for Payer: Galaxy Health WC |
$3,706.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$467.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$239.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$284.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,908.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,046.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$381.61
|
| Rate for Payer: Multiplan Commercial |
$3,488.00
|
| Rate for Payer: Networks By Design Commercial |
$2,834.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,706.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,616.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,616.00
|
| 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: Upland Medical Group Pediatric |
$284.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Vantage Medical Group Senior |
$284.78
|
|
|
HC RADIOPHARM THERAPY Y-90 ZEVALIN
|
Facility
|
IP
|
$4,360.00
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
909301344
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$872.00 |
| Max. Negotiated Rate |
$3,706.00 |
| Rate for Payer: Adventist Health Commercial |
$872.00
|
| Rate for Payer: Cash Price |
$2,398.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,744.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,744.00
|
| Rate for Payer: Galaxy Health WC |
$3,706.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,616.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,908.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,661.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,698.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,046.40
|
| Rate for Payer: Multiplan Commercial |
$3,488.00
|
| Rate for Payer: Networks By Design Commercial |
$2,834.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,706.00
|
|
|
HC RADIOPHRM AGNT OF TMR SNGL DAY
|
Facility
|
OP
|
$4,468.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
909301440
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$260.23 |
| Max. Negotiated Rate |
$3,797.80 |
| Rate for Payer: Adventist Health Commercial |
$893.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,930.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,743.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,734.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,805.07
|
| Rate for Payer: Cash Price |
$2,457.40
|
| Rate for Payer: Cash Price |
$2,457.40
|
| Rate for Payer: Cigna of CA HMO |
$2,859.52
|
| Rate for Payer: Cigna of CA PPO |
$3,306.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$3,797.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,680.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$260.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,980.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,072.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$3,574.40
|
| Rate for Payer: Networks By Design Commercial |
$2,904.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,797.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,680.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,680.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,260.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,260.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,260.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,260.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC RADIOPHRM AGNT OF TMR SNGL DAY
|
Facility
|
IP
|
$4,468.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
909301440
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$893.60 |
| Max. Negotiated Rate |
$3,797.80 |
| Rate for Payer: Adventist Health Commercial |
$893.60
|
| Rate for Payer: Cash Price |
$2,457.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,787.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,787.20
|
| Rate for Payer: Galaxy Health WC |
$3,797.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,680.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,980.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,702.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,765.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,072.32
|
| Rate for Payer: Multiplan Commercial |
$3,574.40
|
| Rate for Payer: Networks By Design Commercial |
$2,904.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,797.80
|
|
|
HC RAGWEED WESTERN IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913638
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$156.13 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.13
|
| Rate for Payer: Blue Shield of California Commercial |
$44.15
|
| Rate for Payer: Blue Shield of California EPN |
$29.17
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC RAGWEED WESTERN IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913638
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC RANGE OF MOTION EXTR/TRUNK EA MCAL
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
900400016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$115.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$197.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.40
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC RANGE OF MOTION EXTR/TRUNK EA MCAL
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
900400016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC RANGE OF MOTION MEAS HAND MCAL
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
900400018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$115.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$197.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.40
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC RANGE OF MOTION MEAS HAND MCAL
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
900400018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
