|
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 |
$1,270.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$463.14
|
| Rate for Payer: Blue Shield of California Commercial |
$425.55
|
| Rate for Payer: Blue Shield of California Commercial |
$280.81
|
| Rate for Payer: Cash Price |
$300.15
|
| Rate for Payer: Cash Price |
$300.15
|
| Rate for Payer: Cash Price |
$300.15
|
| 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 |
$196.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$466.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.53
|
| Rate for Payer: EPIC Health Plan Senior |
$144.35
|
| Rate for Payer: Galaxy Health WC |
$566.95
|
| Rate for Payer: Global Benefits Group Commercial |
$400.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$215.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$131.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$423.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$165.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.85
|
| 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 |
$131.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Vantage Medical Group Senior |
$131.23
|
|
|
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 |
$300.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$466.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$423.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$393.53
|
| 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
|
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 |
$732.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,139.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,033.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$960.52
|
| 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 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 |
$1,676.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$618.94
|
| Rate for Payer: Blue Shield of California Commercial |
$685.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,038.66
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| 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 |
$1,065.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$781.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$710.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,139.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,172.59
|
| Rate for Payer: EPIC Health Plan Senior |
$781.73
|
| 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/Senior |
$1,165.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$710.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,033.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$994.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$895.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$952.28
|
| 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 |
$710.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Vantage Medical Group Senior |
$710.66
|
|
|
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 |
$278.23
|
| 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 |
$152.39
|
| Rate for Payer: Blue Shield of California Commercial |
$880.44
|
| Rate for Payer: Blue Shield of California Commercial |
$580.98
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cash Price |
$621.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$966.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$876.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$814.20
|
| 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 |
$621.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$966.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$876.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$814.20
|
| 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 |
$2,258.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,512.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,186.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,960.62
|
| 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 |
$300.11 |
| Max. Negotiated Rate |
$4,265.30 |
| Rate for Payer: Adventist Health Commercial |
$1,003.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$697.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,220.05
|
| Rate for Payer: Blue Shield of California Commercial |
$3,201.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,112.58
|
| Rate for Payer: Cash Price |
$2,258.10
|
| Rate for Payer: Cash Price |
$2,258.10
|
| 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 |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,512.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.18
|
| Rate for Payer: EPIC Health Plan Senior |
$330.12
|
| 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/Senior |
$492.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$336.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,186.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$402.15
|
| 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 |
$300.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
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 |
$526.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$819.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$743.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$690.89
|
| 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 |
$486.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$751.43
|
| Rate for Payer: Blue Shield of California Commercial |
$747.10
|
| Rate for Payer: Blue Shield of California Commercial |
$492.99
|
| Rate for Payer: Cash Price |
$526.95
|
| Rate for Payer: Cash Price |
$526.95
|
| 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 |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$819.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.18
|
| Rate for Payer: EPIC Health Plan Senior |
$330.12
|
| Rate for Payer: Galaxy Health WC |
$995.35
|
| Rate for Payer: Global Benefits Group Commercial |
$702.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$492.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$743.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$402.15
|
| 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 |
$300.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
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 |
$1,246.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,938.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,758.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.71
|
| 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 |
$427.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,776.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,766.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,165.75
|
| Rate for Payer: Cash Price |
$1,246.05
|
| Rate for Payer: Cash Price |
$1,246.05
|
| 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 |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,938.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.18
|
| Rate for Payer: EPIC Health Plan Senior |
$330.12
|
| 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/Senior |
$492.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,758.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$402.15
|
| 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 |
$300.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
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 |
$393.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$756.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,019.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,545.24
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Cash Price |
$1,089.90
|
| 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 |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,695.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.18
|
| Rate for Payer: EPIC Health Plan Senior |
$330.12
|
| 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/Senior |
$492.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$200.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,537.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$226.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$402.15
|
| 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 |
$300.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
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 |
$1,089.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,695.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,537.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,428.98
|
| 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 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 |
$660.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,797.81
|
| Rate for Payer: Blue Shield of California Commercial |
$2,781.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,835.56
|
| Rate for Payer: Cash Price |
$1,962.00
|
| Rate for Payer: Cash Price |
$1,962.00
|
| 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 |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,052.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.18
|
| Rate for Payer: EPIC Health Plan Senior |
$330.12
|
| 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/Senior |
$492.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$239.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,768.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,046.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$402.15
|
| 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 |
$300.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
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 |
$1,962.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,052.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,768.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,572.40
|
| 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
|
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 |
$2,010.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,127.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,837.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,636.12
|
| 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 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 |
$2,049.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,867.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,850.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,881.03
|
| Rate for Payer: Cash Price |
$2,010.60
|
| Rate for Payer: Cash Price |
$2,010.60
|
| 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 |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,127.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| 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/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$260.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,837.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,072.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$935.79
|
| 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 |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
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 |
$29.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.94
|
| 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 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 |
$163.16 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.38
|
| 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 |
$163.16
|
| Rate for Payer: Blue Shield of California Commercial |
$30.43
|
| Rate for Payer: Blue Shield of California Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| 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 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 |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$115.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.68
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$179.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.38
|
| 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: Cash Price |
$126.90
|
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$179.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.38
|
| 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
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
901300033
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$179.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.38
|
| 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
|
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 |
$126.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$179.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.38
|
| 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 |
901300033
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$115.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.47
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$179.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.38
|
| 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
|
|
