|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
943100516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
942100516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$71.97 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.97
|
| Rate for Payer: Blue Shield of California Commercial |
$15.12
|
| Rate for Payer: Blue Shield of California EPN |
$9.53
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.20
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
942100516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC TC-99 ARCITUMOMAB/CEA TO 45MCI
|
Facility
|
IP
|
$5,382.00
|
|
|
Service Code
|
CPT A9568
|
| Hospital Charge Code |
909301539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,076.40 |
| Max. Negotiated Rate |
$4,843.80 |
| Rate for Payer: Adventist Health Commercial |
$1,076.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,316.36
|
| Rate for Payer: Blue Shield of California EPN |
$2,712.53
|
| Rate for Payer: Cash Price |
$2,421.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,305.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,767.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,152.80
|
| Rate for Payer: Galaxy Health WC |
$4,574.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,229.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,843.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,417.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,175.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.40
|
| Rate for Payer: Multiplan Commercial |
$4,036.50
|
| Rate for Payer: Networks By Design Commercial |
$3,498.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,574.70
|
|
|
HC TC-99 ARCITUMOMAB/CEA TO 45MCI
|
Facility
|
OP
|
$5,382.00
|
|
|
Service Code
|
CPT A9568
|
| Hospital Charge Code |
909301539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,076.40 |
| Max. Negotiated Rate |
$4,843.80 |
| Rate for Payer: Adventist Health Commercial |
$1,076.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,574.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,960.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,036.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,412.19
|
| Rate for Payer: Blue Shield of California EPN |
$2,147.42
|
| Rate for Payer: Cash Price |
$2,421.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,305.60
|
| Rate for Payer: Cigna of CA HMO |
$3,444.48
|
| Rate for Payer: Cigna of CA PPO |
$3,982.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,574.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,574.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,574.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,767.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,152.80
|
| Rate for Payer: Galaxy Health WC |
$4,574.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,229.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,843.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,417.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,953.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,175.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,767.40
|
| Rate for Payer: Multiplan Commercial |
$4,036.50
|
| Rate for Payer: Networks By Design Commercial |
$3,498.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,574.70
|
| Rate for Payer: Riverside University Health System MISP |
$2,152.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,229.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,229.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,691.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,691.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,691.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,574.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,574.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,574.70
|
|
|
HC TC-99 BICISTAE/NUEROLITE LT 25MCI
|
Facility
|
OP
|
$1,693.00
|
|
|
Service Code
|
CPT A9557
|
| Hospital Charge Code |
909301541
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.60 |
| Max. Negotiated Rate |
$1,523.70 |
| Rate for Payer: Adventist Health Commercial |
$338.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$775.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$969.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$853.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$853.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$701.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$875.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,073.36
|
| Rate for Payer: Blue Shield of California EPN |
$675.51
|
| Rate for Payer: Cash Price |
$761.85
|
| Rate for Payer: Cash Price |
$761.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,354.40
|
| Rate for Payer: Cigna of CA HMO |
$1,185.10
|
| Rate for Payer: Cigna of CA PPO |
$1,185.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$969.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$853.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$853.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,185.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,279.61
|
| Rate for Payer: EPIC Health Plan Senior |
$853.07
|
| Rate for Payer: Galaxy Health WC |
$1,439.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,015.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,523.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,271.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$583.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$775.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,075.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$644.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,085.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,039.20
|
| Rate for Payer: Multiplan Commercial |
$1,269.75
|
| Rate for Payer: Networks By Design Commercial |
$846.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$775.52
|
| Rate for Payer: Prime Health Services Commercial |
$1,439.05
|
| Rate for Payer: Prime Health Services Medicare |
$822.05
|
| Rate for Payer: Riverside University Health System MISP |
$853.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,015.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,015.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$635.38
|
| Rate for Payer: United Healthcare All Other HMO |
$618.45
|
| Rate for Payer: United Healthcare HMO Rider |
$605.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$554.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$775.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$969.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$853.07
|
| Rate for Payer: Vantage Medical Group Senior |
$853.07
|
|
|
HC TC-99 BICISTAE/NUEROLITE LT 25MCI
|
Facility
|
IP
|
$1,693.00
|
|
|
Service Code
|
CPT A9557
|
| Hospital Charge Code |
909301541
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.60 |
| Max. Negotiated Rate |
$1,523.70 |
| Rate for Payer: Adventist Health Commercial |
$338.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,357.79
|
| Rate for Payer: Blue Shield of California EPN |
$853.27
|
| Rate for Payer: Cash Price |
$761.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,354.40
|
| Rate for Payer: Cigna of CA HMO |
$1,185.10
|
| Rate for Payer: Cigna of CA PPO |
$1,185.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,185.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$677.20
|
| Rate for Payer: EPIC Health Plan Senior |
$677.20
|
| Rate for Payer: Galaxy Health WC |
$1,439.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,015.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,523.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,075.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$998.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.60
|
| Rate for Payer: Multiplan Commercial |
$1,269.75
|
| Rate for Payer: Networks By Design Commercial |
$846.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,439.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$635.38
|
| Rate for Payer: United Healthcare All Other HMO |
$618.45
|
| Rate for Payer: United Healthcare HMO Rider |
$605.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$554.46
|
|
|
HC TC-99 CERETEC UP TO 25 MCI
|
Facility
|
OP
|
$3,130.00
|
|
|
Service Code
|
CPT A9521
|
| Hospital Charge Code |
909301535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$626.00 |
| Max. Negotiated Rate |
$2,817.00 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,721.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,347.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,546.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,929.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,984.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,248.87
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,504.00
|
| Rate for Payer: Cigna of CA HMO |
$2,191.00
|
| Rate for Payer: Cigna of CA PPO |
$2,191.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,660.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,660.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,817.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$781.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,987.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$862.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,846.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,191.00
|
| Rate for Payer: Multiplan Commercial |
$2,347.50
|
| Rate for Payer: Networks By Design Commercial |
$1,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,878.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,878.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,118.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,025.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,660.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,660.50
|
|
|
HC TC-99 CERETEC UP TO 25 MCI
|
Facility
|
IP
|
$3,130.00
|
|
|
Service Code
|
CPT A9521
|
| Hospital Charge Code |
909301535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$626.00 |
| Max. Negotiated Rate |
$2,817.00 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,510.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,577.52
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,504.00
|
| Rate for Payer: Cigna of CA HMO |
$2,191.00
|
| Rate for Payer: Cigna of CA PPO |
$2,191.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,817.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,987.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,846.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.00
|
| Rate for Payer: Multiplan Commercial |
$2,347.50
|
| Rate for Payer: Networks By Design Commercial |
$1,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,118.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,025.08
|
|
|
HC TC-99 GHT UP TO 25 MCI
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT A9550
|
| Hospital Charge Code |
909301509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Adventist Health Commercial |
$51.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$217.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.00
|
| Rate for Payer: Blue Shield of California Commercial |
$162.30
|
| Rate for Payer: Blue Shield of California EPN |
$102.14
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Central Health Plan Commercial |
$204.80
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$179.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$217.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$217.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$179.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.40
|
| Rate for Payer: EPIC Health Plan Senior |
$102.40
|
| Rate for Payer: Galaxy Health WC |
$217.60
|
| Rate for Payer: Global Benefits Group Commercial |
$153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$162.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$179.20
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Networks By Design Commercial |
$128.00
|
| Rate for Payer: Prime Health Services Commercial |
$217.60
|
| Rate for Payer: Riverside University Health System MISP |
$102.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.08
|
| Rate for Payer: United Healthcare All Other HMO |
$93.52
|
| Rate for Payer: United Healthcare HMO Rider |
$91.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$217.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$217.60
|
| Rate for Payer: Vantage Medical Group Senior |
$217.60
|
|
|
HC TC-99 GHT UP TO 25 MCI
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT A9550
|
| Hospital Charge Code |
909301509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Adventist Health Commercial |
$51.20
|
| Rate for Payer: Blue Shield of California Commercial |
$205.31
|
| Rate for Payer: Blue Shield of California EPN |
$129.02
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Central Health Plan Commercial |
$204.80
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$179.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$179.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.40
|
| Rate for Payer: EPIC Health Plan Senior |
$102.40
|
| Rate for Payer: Galaxy Health WC |
$217.60
|
| Rate for Payer: Global Benefits Group Commercial |
$153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$162.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.20
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Networks By Design Commercial |
$128.00
|
| Rate for Payer: Prime Health Services Commercial |
$217.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.08
|
| Rate for Payer: United Healthcare All Other HMO |
$93.52
|
| Rate for Payer: United Healthcare HMO Rider |
$91.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.84
|
|
|
HC TC-99 HEPATOLITE UP TO 15 MCI
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT A9510
|
| Hospital Charge Code |
909301505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Blue Shield of California Commercial |
$360.10
|
| Rate for Payer: Blue Shield of California EPN |
$226.30
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Central Health Plan Commercial |
$359.20
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$404.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.80
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
|
|
HC TC-99 HEPATOLITE UP TO 15 MCI
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT A9510
|
| Hospital Charge Code |
909301505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.49
|
| Rate for Payer: Blue Shield of California Commercial |
$284.67
|
| Rate for Payer: Blue Shield of California EPN |
$179.15
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Central Health Plan Commercial |
$359.20
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$381.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$381.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$404.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$314.30
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Riverside University Health System MISP |
$179.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$381.65
|
| Rate for Payer: Vantage Medical Group Senior |
$381.65
|
|
|
HC TC-99 MAA UP TO 10 MCI
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT A9540
|
| Hospital Charge Code |
909301506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Blue Shield of California Commercial |
$235.79
|
| Rate for Payer: Blue Shield of California EPN |
$148.18
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Central Health Plan Commercial |
$235.20
|
| Rate for Payer: Cigna of CA HMO |
$205.80
|
| Rate for Payer: Cigna of CA PPO |
$205.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Networks By Design Commercial |
$147.00
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.34
|
| Rate for Payer: United Healthcare All Other HMO |
$107.40
|
| Rate for Payer: United Healthcare HMO Rider |
$105.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.28
|
|
|
HC TC-99 MAA UP TO 10 MCI
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT A9540
|
| Hospital Charge Code |
909301506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.23
|
| Rate for Payer: Blue Shield of California Commercial |
$186.40
|
| Rate for Payer: Blue Shield of California EPN |
$117.31
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Central Health Plan Commercial |
$235.20
|
| Rate for Payer: Cigna of CA HMO |
$205.80
|
| Rate for Payer: Cigna of CA PPO |
$205.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Networks By Design Commercial |
$147.00
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Riverside University Health System MISP |
$117.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.34
|
| Rate for Payer: United Healthcare All Other HMO |
$107.40
|
| Rate for Payer: United Healthcare HMO Rider |
$105.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
|
|
HC TC-99M APCITIDE/ACCUTEC LT 20MCI
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
CPT A9504
|
| Hospital Charge Code |
909301540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$386.60 |
| Max. Negotiated Rate |
$1,739.70 |
| Rate for Payer: Adventist Health Commercial |
$386.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,550.27
|
| Rate for Payer: Blue Shield of California EPN |
$974.23
|
| Rate for Payer: Cash Price |
$869.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,546.40
|
| Rate for Payer: Cigna of CA HMO |
$1,353.10
|
| Rate for Payer: Cigna of CA PPO |
$1,353.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,353.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$773.20
|
| Rate for Payer: EPIC Health Plan Senior |
$773.20
|
| Rate for Payer: Galaxy Health WC |
$1,643.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,159.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,739.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,227.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,140.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.60
|
| Rate for Payer: Multiplan Commercial |
$1,449.75
|
| Rate for Payer: Networks By Design Commercial |
$966.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,643.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.45
|
| Rate for Payer: United Healthcare All Other HMO |
$706.12
|
| Rate for Payer: United Healthcare HMO Rider |
$690.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$633.06
|
|
|
HC TC-99M APCITIDE/ACCUTEC LT 20MCI
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
CPT A9504
|
| Hospital Charge Code |
909301540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$386.60 |
| Max. Negotiated Rate |
$1,739.70 |
| Rate for Payer: Adventist Health Commercial |
$386.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,643.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,063.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,449.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$824.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,225.52
|
| Rate for Payer: Blue Shield of California EPN |
$771.27
|
| Rate for Payer: Cash Price |
$869.85
|
| Rate for Payer: Cash Price |
$869.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,546.40
|
| Rate for Payer: Cigna of CA HMO |
$1,353.10
|
| Rate for Payer: Cigna of CA PPO |
$1,353.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,643.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,643.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,643.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,353.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$773.20
|
| Rate for Payer: EPIC Health Plan Senior |
$773.20
|
| Rate for Payer: Galaxy Health WC |
$1,643.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,159.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,739.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$653.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,227.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,140.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,353.10
|
| Rate for Payer: Multiplan Commercial |
$1,449.75
|
| Rate for Payer: Networks By Design Commercial |
$966.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,643.05
|
| Rate for Payer: Riverside University Health System MISP |
$773.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,159.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,159.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.45
|
| Rate for Payer: United Healthcare All Other HMO |
$706.12
|
| Rate for Payer: United Healthcare HMO Rider |
$690.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$633.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,643.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,643.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,643.05
|
|
|
HC TC-99M DEPREOTID NEOTEC LT 35MCI
|
Facility
|
OP
|
$2,398.00
|
|
|
Service Code
|
CPT A9536
|
| Hospital Charge Code |
909301542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$479.60 |
| Max. Negotiated Rate |
$2,158.20 |
| Rate for Payer: Adventist Health Commercial |
$479.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,038.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,318.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,798.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,392.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,737.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,520.33
|
| Rate for Payer: Blue Shield of California EPN |
$956.80
|
| Rate for Payer: Cash Price |
$1,079.10
|
| Rate for Payer: Cash Price |
$1,079.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,918.40
|
| Rate for Payer: Cigna of CA HMO |
$1,678.60
|
| Rate for Payer: Cigna of CA PPO |
$1,678.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,038.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,038.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,678.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$959.20
|
| Rate for Payer: EPIC Health Plan Senior |
$959.20
|
| Rate for Payer: Galaxy Health WC |
$2,038.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,438.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,158.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,045.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,522.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,155.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,414.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,678.60
|
| Rate for Payer: Multiplan Commercial |
$1,798.50
|
| Rate for Payer: Networks By Design Commercial |
$1,199.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,038.30
|
| Rate for Payer: Riverside University Health System MISP |
$959.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,438.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,438.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$899.97
|
| Rate for Payer: United Healthcare All Other HMO |
$875.99
|
| Rate for Payer: United Healthcare HMO Rider |
$857.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$785.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,038.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,038.30
|
|
|
HC TC-99M DEPREOTID NEOTEC LT 35MCI
|
Facility
|
IP
|
$2,398.00
|
|
|
Service Code
|
CPT A9536
|
| Hospital Charge Code |
909301542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$479.60 |
| Max. Negotiated Rate |
$2,158.20 |
| Rate for Payer: Adventist Health Commercial |
$479.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,923.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,208.59
|
| Rate for Payer: Cash Price |
$1,079.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,918.40
|
| Rate for Payer: Cigna of CA HMO |
$1,678.60
|
| Rate for Payer: Cigna of CA PPO |
$1,678.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,678.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$959.20
|
| Rate for Payer: EPIC Health Plan Senior |
$959.20
|
| Rate for Payer: Galaxy Health WC |
$2,038.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,438.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,158.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,522.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,414.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.60
|
| Rate for Payer: Multiplan Commercial |
$1,798.50
|
| Rate for Payer: Networks By Design Commercial |
$1,199.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,038.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$899.97
|
| Rate for Payer: United Healthcare All Other HMO |
$875.99
|
| Rate for Payer: United Healthcare HMO Rider |
$857.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$785.35
|
|
|
HC TC-99 MEBROFEN/CHOLETEC LT 15MCI
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT A9537
|
| Hospital Charge Code |
909301537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.02 |
| Max. Negotiated Rate |
$977.40 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$923.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$597.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$814.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.16
|
| Rate for Payer: Blue Shield of California Commercial |
$688.52
|
| Rate for Payer: Blue Shield of California EPN |
$433.31
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Central Health Plan Commercial |
$868.80
|
| Rate for Payer: Cigna of CA HMO |
$760.20
|
| Rate for Payer: Cigna of CA PPO |
$760.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$923.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$923.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$760.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$977.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$689.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$640.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.20
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
| Rate for Payer: Networks By Design Commercial |
$543.00
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
| Rate for Payer: Riverside University Health System MISP |
$434.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$651.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$651.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$407.58
|
| Rate for Payer: United Healthcare All Other HMO |
$396.72
|
| Rate for Payer: United Healthcare HMO Rider |
$388.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$355.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$923.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.10
|
| Rate for Payer: Vantage Medical Group Senior |
$923.10
|
|
|
HC TC-99 MEBROFEN/CHOLETEC LT 15MCI
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT A9537
|
| Hospital Charge Code |
909301537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$977.40 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Blue Shield of California Commercial |
$870.97
|
| Rate for Payer: Blue Shield of California EPN |
$547.34
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Central Health Plan Commercial |
$868.80
|
| Rate for Payer: Cigna of CA HMO |
$760.20
|
| Rate for Payer: Cigna of CA PPO |
$760.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$760.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$977.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$689.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$640.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.20
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
| Rate for Payer: Networks By Design Commercial |
$543.00
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$407.58
|
| Rate for Payer: United Healthcare All Other HMO |
$396.72
|
| Rate for Payer: United Healthcare HMO Rider |
$388.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$355.67
|
|
|
HC TC-99 MEDRONATE/MDP LT 30MCI
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT A9503
|
| Hospital Charge Code |
909301508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$267.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.17
|
| Rate for Payer: Blue Shield of California Commercial |
$186.40
|
| Rate for Payer: Blue Shield of California EPN |
$117.31
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Central Health Plan Commercial |
$235.20
|
| Rate for Payer: Cigna of CA HMO |
$205.80
|
| Rate for Payer: Cigna of CA PPO |
$205.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Networks By Design Commercial |
$147.00
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Riverside University Health System MISP |
$117.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.34
|
| Rate for Payer: United Healthcare All Other HMO |
$107.40
|
| Rate for Payer: United Healthcare HMO Rider |
$105.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
|
|
HC TC-99 MEDRONATE/MDP LT 30MCI
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT A9503
|
| Hospital Charge Code |
909301508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Blue Shield of California Commercial |
$235.79
|
| Rate for Payer: Blue Shield of California EPN |
$148.18
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Central Health Plan Commercial |
$235.20
|
| Rate for Payer: Cigna of CA HMO |
$205.80
|
| Rate for Payer: Cigna of CA PPO |
$205.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Networks By Design Commercial |
$147.00
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.34
|
| Rate for Payer: United Healthcare All Other HMO |
$107.40
|
| Rate for Payer: United Healthcare HMO Rider |
$105.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.28
|
|
|
HC TC-99 MERTIATIDE/MAG3 LT 15MCI
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
CPT A9562
|
| Hospital Charge Code |
909301531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$399.40 |
| Max. Negotiated Rate |
$1,797.30 |
| Rate for Payer: Adventist Health Commercial |
$399.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,601.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,006.49
|
| Rate for Payer: Cash Price |
$898.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,597.60
|
| Rate for Payer: Cigna of CA HMO |
$1,397.90
|
| Rate for Payer: Cigna of CA PPO |
$1,397.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,397.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$798.80
|
| Rate for Payer: EPIC Health Plan Senior |
$798.80
|
| Rate for Payer: Galaxy Health WC |
$1,697.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,198.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,797.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,268.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,178.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.40
|
| Rate for Payer: Multiplan Commercial |
$1,497.75
|
| Rate for Payer: Networks By Design Commercial |
$998.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,697.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$749.47
|
| Rate for Payer: United Healthcare All Other HMO |
$729.50
|
| Rate for Payer: United Healthcare HMO Rider |
$713.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.02
|
|
