|
HC TC-99 MERTIATIDE/MAG3 LT 15MCI
|
Facility
|
OP
|
$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: Alpha Care Medical Group Commercial/Exchange |
$1,697.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,098.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,497.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$816.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,018.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,266.10
|
| Rate for Payer: Blue Shield of California EPN |
$796.80
|
| Rate for Payer: Cash Price |
$898.65
|
| 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: Dignity Health Commercial/Exchange |
$1,697.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,697.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,697.45
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$528.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,268.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$583.26
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$1,397.90
|
| 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: Riverside University Health System MISP |
$798.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,198.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,198.20
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,697.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,697.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,697.45
|
|
|
HC TC-99M PERTECHNETATE PER MCI
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT A9512
|
| Hospital Charge Code |
909301501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Blue Shield of California Commercial |
$230.17
|
| Rate for Payer: Blue Shield of California EPN |
$144.65
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Central Health Plan Commercial |
$229.60
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$258.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$215.25
|
| Rate for Payer: Networks By Design Commercial |
$143.50
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Other HMO |
$104.84
|
| Rate for Payer: United Healthcare HMO Rider |
$102.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.99
|
|
|
HC TC-99M PERTECHNETATE PER MCI
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT A9512
|
| Hospital Charge Code |
909301501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.96
|
| Rate for Payer: Blue Shield of California Commercial |
$181.96
|
| Rate for Payer: Blue Shield of California EPN |
$114.51
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Central Health Plan Commercial |
$229.60
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$258.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$200.90
|
| Rate for Payer: Multiplan Commercial |
$215.25
|
| Rate for Payer: Networks By Design Commercial |
$143.50
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Riverside University Health System MISP |
$114.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Other HMO |
$104.84
|
| Rate for Payer: United Healthcare HMO Rider |
$102.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
HC TC-99 OXIDRONATE/HDP LT 30MCI
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT A9561
|
| Hospital Charge Code |
909301536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$369.90 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Blue Shield of California Commercial |
$329.62
|
| Rate for Payer: Blue Shield of California EPN |
$207.14
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Central Health Plan Commercial |
$328.80
|
| Rate for Payer: Cigna of CA HMO |
$287.70
|
| Rate for Payer: Cigna of CA PPO |
$287.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.20
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| Rate for Payer: Networks By Design Commercial |
$205.50
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$154.25
|
| Rate for Payer: United Healthcare All Other HMO |
$150.14
|
| Rate for Payer: United Healthcare HMO Rider |
$146.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.60
|
|
|
HC TC-99 OXIDRONATE/HDP LT 30MCI
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT A9561
|
| Hospital Charge Code |
909301536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.58 |
| Max. Negotiated Rate |
$369.90 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.08
|
| Rate for Payer: Blue Shield of California Commercial |
$260.57
|
| Rate for Payer: Blue Shield of California EPN |
$163.99
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Central Health Plan Commercial |
$328.80
|
| Rate for Payer: Cigna of CA HMO |
$287.70
|
| Rate for Payer: Cigna of CA PPO |
$287.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$349.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$349.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$287.70
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| Rate for Payer: Networks By Design Commercial |
$205.50
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
| Rate for Payer: Riverside University Health System MISP |
$164.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$154.25
|
| Rate for Payer: United Healthcare All Other HMO |
$150.14
|
| Rate for Payer: United Healthcare HMO Rider |
$146.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$349.35
|
| Rate for Payer: Vantage Medical Group Senior |
$349.35
|
|
|
HC TC-99 PENTETATE/DTPA LT 25MCI
|
Facility
|
IP
|
$1,036.00
|
|
|
Service Code
|
CPT A9539
|
| Hospital Charge Code |
909301510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.20 |
| Max. Negotiated Rate |
$932.40 |
| Rate for Payer: Adventist Health Commercial |
$207.20
|
| Rate for Payer: Blue Shield of California Commercial |
$830.87
|
| Rate for Payer: Blue Shield of California EPN |
$522.14
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Central Health Plan Commercial |
$828.80
|
| Rate for Payer: Cigna of CA HMO |
$725.20
|
| Rate for Payer: Cigna of CA PPO |
$725.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$725.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.40
|
| Rate for Payer: EPIC Health Plan Senior |
$414.40
|
| Rate for Payer: Galaxy Health WC |
$880.60
|
| Rate for Payer: Global Benefits Group Commercial |
$621.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$932.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$611.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$777.00
|
| Rate for Payer: Networks By Design Commercial |
$518.00
|
| Rate for Payer: Prime Health Services Commercial |
$880.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$388.81
|
| Rate for Payer: United Healthcare All Other HMO |
$378.45
|
| Rate for Payer: United Healthcare HMO Rider |
$370.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$339.29
|
|
|
HC TC-99 PENTETATE/DTPA LT 25MCI
|
Facility
|
OP
|
$1,036.00
|
|
|
Service Code
|
CPT A9539
|
| Hospital Charge Code |
909301510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$932.40 |
| Rate for Payer: Adventist Health Commercial |
$207.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$880.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$569.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.16
|
| Rate for Payer: Blue Shield of California Commercial |
$656.82
|
| Rate for Payer: Blue Shield of California EPN |
$413.36
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Central Health Plan Commercial |
$828.80
|
| Rate for Payer: Cigna of CA HMO |
$725.20
|
| Rate for Payer: Cigna of CA PPO |
$725.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$880.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$880.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$880.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$725.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.40
|
| Rate for Payer: EPIC Health Plan Senior |
$414.40
|
| Rate for Payer: Galaxy Health WC |
$880.60
|
| Rate for Payer: Global Benefits Group Commercial |
$621.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$932.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$611.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$725.20
|
| Rate for Payer: Multiplan Commercial |
$777.00
|
| Rate for Payer: Networks By Design Commercial |
$518.00
|
| Rate for Payer: Prime Health Services Commercial |
$880.60
|
| Rate for Payer: Riverside University Health System MISP |
$414.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$621.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$388.81
|
| Rate for Payer: United Healthcare All Other HMO |
$378.45
|
| Rate for Payer: United Healthcare HMO Rider |
$370.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$339.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$880.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$880.60
|
| Rate for Payer: Vantage Medical Group Senior |
$880.60
|
|
|
HC TC-99 PYROPHOSPHATE LT 25 MCI
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
909301507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.80 |
| Max. Negotiated Rate |
$552.60 |
| Rate for Payer: Adventist Health Commercial |
$122.80
|
| Rate for Payer: Blue Shield of California Commercial |
$492.43
|
| Rate for Payer: Blue Shield of California EPN |
$309.46
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Central Health Plan Commercial |
$491.20
|
| Rate for Payer: Cigna of CA HMO |
$429.80
|
| Rate for Payer: Cigna of CA PPO |
$429.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$429.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.60
|
| Rate for Payer: EPIC Health Plan Senior |
$245.60
|
| Rate for Payer: Galaxy Health WC |
$521.90
|
| Rate for Payer: Global Benefits Group Commercial |
$368.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$552.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$362.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.80
|
| Rate for Payer: Multiplan Commercial |
$460.50
|
| Rate for Payer: Networks By Design Commercial |
$307.00
|
| Rate for Payer: Prime Health Services Commercial |
$521.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.43
|
| Rate for Payer: United Healthcare All Other HMO |
$224.29
|
| Rate for Payer: United Healthcare HMO Rider |
$219.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.09
|
|
|
HC TC-99 PYROPHOSPHATE LT 25 MCI
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
909301507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.26 |
| Max. Negotiated Rate |
$552.60 |
| Rate for Payer: Adventist Health Commercial |
$122.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$521.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$460.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.48
|
| Rate for Payer: Blue Shield of California Commercial |
$389.28
|
| Rate for Payer: Blue Shield of California EPN |
$244.99
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Central Health Plan Commercial |
$491.20
|
| Rate for Payer: Cigna of CA HMO |
$429.80
|
| Rate for Payer: Cigna of CA PPO |
$429.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$521.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$521.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$521.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$429.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.60
|
| Rate for Payer: EPIC Health Plan Senior |
$245.60
|
| Rate for Payer: Galaxy Health WC |
$521.90
|
| Rate for Payer: Global Benefits Group Commercial |
$368.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$552.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$362.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$429.80
|
| Rate for Payer: Multiplan Commercial |
$460.50
|
| Rate for Payer: Networks By Design Commercial |
$307.00
|
| Rate for Payer: Prime Health Services Commercial |
$521.90
|
| Rate for Payer: Riverside University Health System MISP |
$245.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$368.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$368.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.43
|
| Rate for Payer: United Healthcare All Other HMO |
$224.29
|
| Rate for Payer: United Healthcare HMO Rider |
$219.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$521.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$521.90
|
| Rate for Payer: Vantage Medical Group Senior |
$521.90
|
|
|
HC TC-99 SUCCIMER/DMSA LT 10 MCI
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT A9551
|
| Hospital Charge Code |
909301500
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$1,088.88 |
| Rate for Payer: Adventist Health Commercial |
$141.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$659.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$989.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$725.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$659.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$232.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$289.58
|
| Rate for Payer: Blue Shield of California Commercial |
$447.60
|
| Rate for Payer: Blue Shield of California EPN |
$281.69
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Central Health Plan Commercial |
$564.80
|
| Rate for Payer: Cigna of CA HMO |
$494.20
|
| Rate for Payer: Cigna of CA PPO |
$494.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$989.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$725.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$659.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$494.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,088.88
|
| Rate for Payer: EPIC Health Plan Senior |
$725.92
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$635.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,082.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$174.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$659.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$448.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$884.31
|
| Rate for Payer: Multiplan Commercial |
$529.50
|
| Rate for Payer: Networks By Design Commercial |
$353.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$659.93
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
| Rate for Payer: Prime Health Services Medicare |
$699.53
|
| Rate for Payer: Riverside University Health System MISP |
$725.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$423.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Other HMO |
$257.90
|
| Rate for Payer: United Healthcare HMO Rider |
$252.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$231.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$659.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$989.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$725.92
|
| Rate for Payer: Vantage Medical Group Senior |
$659.93
|
|
|
HC TC-99 SUCCIMER/DMSA LT 10 MCI
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT A9551
|
| Hospital Charge Code |
909301500
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$635.40 |
| Rate for Payer: Adventist Health Commercial |
$141.20
|
| Rate for Payer: Blue Shield of California Commercial |
$566.21
|
| Rate for Payer: Blue Shield of California EPN |
$355.82
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Central Health Plan Commercial |
$564.80
|
| Rate for Payer: Cigna of CA HMO |
$494.20
|
| Rate for Payer: Cigna of CA PPO |
$494.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$494.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$635.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$448.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$416.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.20
|
| Rate for Payer: Multiplan Commercial |
$529.50
|
| Rate for Payer: Networks By Design Commercial |
$353.00
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Other HMO |
$257.90
|
| Rate for Payer: United Healthcare HMO Rider |
$252.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$231.22
|
|
|
HC TC-99 TETROFOSMN/MYOVIEW LT 40MCI
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
CPT A9502
|
| Hospital Charge Code |
909301544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.40 |
| Max. Negotiated Rate |
$528.30 |
| Rate for Payer: Adventist Health Commercial |
$117.40
|
| Rate for Payer: Blue Shield of California Commercial |
$470.77
|
| Rate for Payer: Blue Shield of California EPN |
$295.85
|
| Rate for Payer: Cash Price |
$264.15
|
| Rate for Payer: Central Health Plan Commercial |
$469.60
|
| Rate for Payer: Cigna of CA HMO |
$410.90
|
| Rate for Payer: Cigna of CA PPO |
$410.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$410.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.80
|
| Rate for Payer: EPIC Health Plan Senior |
$234.80
|
| Rate for Payer: Galaxy Health WC |
$498.95
|
| Rate for Payer: Global Benefits Group Commercial |
$352.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$528.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$372.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$346.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.40
|
| Rate for Payer: Multiplan Commercial |
$440.25
|
| Rate for Payer: Networks By Design Commercial |
$293.50
|
| Rate for Payer: Prime Health Services Commercial |
$498.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.30
|
| Rate for Payer: United Healthcare All Other HMO |
$214.43
|
| Rate for Payer: United Healthcare HMO Rider |
$209.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$192.24
|
|
|
HC TC-99 TETROFOSMN/MYOVIEW LT 40MCI
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
CPT A9502
|
| Hospital Charge Code |
909301544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.40 |
| Max. Negotiated Rate |
$528.30 |
| Rate for Payer: Adventist Health Commercial |
$117.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$498.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$322.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$440.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$207.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.32
|
| Rate for Payer: Blue Shield of California Commercial |
$372.16
|
| Rate for Payer: Blue Shield of California EPN |
$234.21
|
| Rate for Payer: Cash Price |
$264.15
|
| Rate for Payer: Cash Price |
$264.15
|
| Rate for Payer: Central Health Plan Commercial |
$469.60
|
| Rate for Payer: Cigna of CA HMO |
$410.90
|
| Rate for Payer: Cigna of CA PPO |
$410.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$498.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$498.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$498.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$410.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.80
|
| Rate for Payer: EPIC Health Plan Senior |
$234.80
|
| Rate for Payer: Galaxy Health WC |
$498.95
|
| Rate for Payer: Global Benefits Group Commercial |
$352.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$528.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$166.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$372.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$184.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$346.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$410.90
|
| Rate for Payer: Multiplan Commercial |
$440.25
|
| Rate for Payer: Networks By Design Commercial |
$293.50
|
| Rate for Payer: Prime Health Services Commercial |
$498.95
|
| Rate for Payer: Riverside University Health System MISP |
$234.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$352.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$352.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.30
|
| Rate for Payer: United Healthcare All Other HMO |
$214.43
|
| Rate for Payer: United Healthcare HMO Rider |
$209.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$192.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$498.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$498.95
|
| Rate for Payer: Vantage Medical Group Senior |
$498.95
|
|
|
HC TC-99 ULTRATAG UP TO 30 MCI
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
CPT A9560
|
| Hospital Charge Code |
909301534
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$725.40 |
| Rate for Payer: Adventist Health Commercial |
$161.20
|
| Rate for Payer: Blue Shield of California Commercial |
$646.41
|
| Rate for Payer: Blue Shield of California EPN |
$406.22
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Central Health Plan Commercial |
$644.80
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$725.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$511.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$475.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.20
|
| Rate for Payer: Multiplan Commercial |
$604.50
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
|
|
HC TC-99 ULTRATAG UP TO 30 MCI
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
CPT A9560
|
| Hospital Charge Code |
909301534
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$725.40 |
| Rate for Payer: Adventist Health Commercial |
$161.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$604.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$208.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.70
|
| Rate for Payer: Blue Shield of California Commercial |
$511.00
|
| Rate for Payer: Blue Shield of California EPN |
$321.59
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Central Health Plan Commercial |
$644.80
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$685.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$725.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$511.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$475.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$564.20
|
| Rate for Payer: Multiplan Commercial |
$604.50
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: Riverside University Health System MISP |
$322.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.10
|
| Rate for Payer: Vantage Medical Group Senior |
$685.10
|
|
|
HC TCATH RMVL OR DBLK ICAR MASS OR VEG
|
Facility
|
IP
|
$11,363.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
906811644
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,272.60 |
| Max. Negotiated Rate |
$10,226.70 |
| Rate for Payer: Adventist Health Commercial |
$2,272.60
|
| Rate for Payer: Cash Price |
$5,113.35
|
| Rate for Payer: Central Health Plan Commercial |
$9,090.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,954.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,545.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,545.20
|
| Rate for Payer: Galaxy Health WC |
$9,658.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,817.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,226.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,215.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,704.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,272.60
|
| Rate for Payer: Multiplan Commercial |
$8,522.25
|
| Rate for Payer: Networks By Design Commercial |
$7,385.95
|
| Rate for Payer: Prime Health Services Commercial |
$9,658.55
|
|
|
HC TCATH RMVL OR DBLK ICAR MASS OR VEG
|
Facility
|
OP
|
$11,363.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
906811644
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,272.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,320.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,501.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,609.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$5,113.35
|
| Rate for Payer: Cash Price |
$5,113.35
|
| Rate for Payer: Cash Price |
$5,113.35
|
| Rate for Payer: Central Health Plan Commercial |
$9,090.40
|
| Rate for Payer: Cigna of CA HMO |
$7,385.95
|
| Rate for Payer: Cigna of CA PPO |
$8,408.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,954.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,078.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8,052.33
|
| Rate for Payer: Galaxy Health WC |
$9,658.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,817.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,226.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,005.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,215.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,124.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,272.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$8,522.25
|
| Rate for Payer: Networks By Design Commercial |
$7,385.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,658.55
|
| Rate for Payer: Prime Health Services Medicare |
$7,759.52
|
| Rate for Payer: Riverside University Health System MISP |
$8,052.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,817.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,817.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,681.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,320.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
HC TCAT IMPL WRLS L ATR PRS SNR
|
Facility
|
IP
|
$8,783.00
|
|
|
Service Code
|
CPT 0933T
|
| Hospital Charge Code |
906811517
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,756.60 |
| Max. Negotiated Rate |
$7,904.70 |
| Rate for Payer: Adventist Health Commercial |
$1,756.60
|
| Rate for Payer: Cash Price |
$3,952.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,026.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,148.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,513.20
|
| Rate for Payer: Galaxy Health WC |
$7,465.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,269.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,904.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,577.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,181.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,756.60
|
| Rate for Payer: Multiplan Commercial |
$6,587.25
|
| Rate for Payer: Networks By Design Commercial |
$5,708.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,465.55
|
|
|
HC TCAT IMPL WRLS L ATR PRS SNR
|
Facility
|
OP
|
$8,783.00
|
|
|
Service Code
|
CPT 0933T
|
| Hospital Charge Code |
906811517
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$1,756.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,169.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,333.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$3,952.35
|
| Rate for Payer: Cash Price |
$3,952.35
|
| Rate for Payer: Cash Price |
$3,952.35
|
| Rate for Payer: Cash Price |
$3,952.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,026.40
|
| Rate for Payer: Cigna of CA HMO |
$5,621.12
|
| Rate for Payer: Cigna of CA PPO |
$6,499.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,148.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,879.96
|
| Rate for Payer: EPIC Health Plan Senior |
$4,586.64
|
| Rate for Payer: Galaxy Health WC |
$7,465.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,269.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,904.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,838.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,577.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,188.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,837.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,756.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,587.36
|
| Rate for Payer: Multiplan Commercial |
$6,587.25
|
| Rate for Payer: Networks By Design Commercial |
$5,708.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Prime Health Services Commercial |
$7,465.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,419.85
|
| Rate for Payer: Riverside University Health System MISP |
$4,586.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,269.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,269.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,169.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
HC TCAT IMPL WRLS PUL ART PRS SNR
|
Facility
|
OP
|
$17,711.00
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
906811492
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$474.50 |
| Max. Negotiated Rate |
$60,871.12 |
| Rate for Payer: Adventist Health Commercial |
$3,542.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$36,891.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55,337.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40,580.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,891.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,157.93
|
| Rate for Payer: Blue Shield of California EPN |
$7,031.27
|
| Rate for Payer: Cash Price |
$7,969.95
|
| Rate for Payer: Cash Price |
$7,969.95
|
| Rate for Payer: Cash Price |
$7,969.95
|
| Rate for Payer: Cash Price |
$7,969.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,168.80
|
| Rate for Payer: Cigna of CA HMO |
$11,335.04
|
| Rate for Payer: Cigna of CA PPO |
$13,106.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55,337.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$40,580.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36,891.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,397.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60,871.12
|
| Rate for Payer: EPIC Health Plan Senior |
$40,580.75
|
| Rate for Payer: Galaxy Health WC |
$15,054.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,626.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,939.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$60,502.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$474.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,891.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,246.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$524.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51,648.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,542.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49,434.73
|
| Rate for Payer: Multiplan Commercial |
$13,283.25
|
| Rate for Payer: Networks By Design Commercial |
$11,512.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$36,891.59
|
| Rate for Payer: Prime Health Services Commercial |
$15,054.35
|
| Rate for Payer: Prime Health Services Medicare |
$39,105.09
|
| Rate for Payer: Riverside University Health System MISP |
$40,580.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,626.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,626.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$36,891.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55,337.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40,580.75
|
| Rate for Payer: Vantage Medical Group Senior |
$36,891.59
|
|
|
HC TCAT IMPL WRLS PUL ART PRS SNR
|
Facility
|
IP
|
$17,711.00
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
906811492
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$3,542.20 |
| Max. Negotiated Rate |
$15,939.90 |
| Rate for Payer: Adventist Health Commercial |
$3,542.20
|
| Rate for Payer: Cash Price |
$7,969.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,168.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,397.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,084.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,084.40
|
| Rate for Payer: Galaxy Health WC |
$15,054.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,626.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,939.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,246.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,449.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,542.20
|
| Rate for Payer: Multiplan Commercial |
$13,283.25
|
| Rate for Payer: Networks By Design Commercial |
$11,512.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,054.35
|
|
|
HC TCAT INTRA COR INFUS SUPSAT OXY
|
Facility
|
OP
|
$2,095.00
|
|
|
Service Code
|
CPT 0659T
|
| Hospital Charge Code |
906810659
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$419.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$419.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,152.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,571.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,014.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,218.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,676.00
|
| Rate for Payer: Cigna of CA HMO |
$1,361.75
|
| Rate for Payer: Cigna of CA PPO |
$1,550.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,780.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,780.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,466.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$838.00
|
| Rate for Payer: Galaxy Health WC |
$1,780.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,885.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,330.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$760.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,236.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,466.50
|
| Rate for Payer: Multiplan Commercial |
$1,571.25
|
| Rate for Payer: Networks By Design Commercial |
$1,361.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,780.75
|
| Rate for Payer: Riverside University Health System MISP |
$838.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,257.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,257.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,047.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,780.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,780.75
|
|
|
HC TCAT INTRA COR INFUS SUPSAT OXY
|
Facility
|
IP
|
$2,095.00
|
|
|
Service Code
|
CPT 0659T
|
| Hospital Charge Code |
906810659
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$419.00 |
| Max. Negotiated Rate |
$1,885.50 |
| Rate for Payer: Adventist Health Commercial |
$419.00
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,676.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,466.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$838.00
|
| Rate for Payer: Galaxy Health WC |
$1,780.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,885.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,330.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,236.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.00
|
| Rate for Payer: Multiplan Commercial |
$1,571.25
|
| Rate for Payer: Networks By Design Commercial |
$1,361.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,780.75
|
|
|
HC TCAT PLMT AND OR RMVL CEREBRAL EMOLIC
|
Facility
|
IP
|
$56,510.00
|
|
|
Service Code
|
CPT 33370
|
| Hospital Charge Code |
906813370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,302.00 |
| Max. Negotiated Rate |
$50,859.00 |
| Rate for Payer: Adventist Health Commercial |
$11,302.00
|
| Rate for Payer: Cash Price |
$25,429.50
|
| Rate for Payer: Central Health Plan Commercial |
$45,208.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39,557.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,604.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22,604.00
|
| Rate for Payer: Galaxy Health WC |
$48,033.50
|
| Rate for Payer: Global Benefits Group Commercial |
$33,906.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$50,859.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35,883.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,340.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,302.00
|
| Rate for Payer: Multiplan Commercial |
$42,382.50
|
| Rate for Payer: Networks By Design Commercial |
$36,731.50
|
| Rate for Payer: Prime Health Services Commercial |
$48,033.50
|
|
|
HC TCAT PLMT AND OR RMVL CEREBRAL EMOLIC
|
Facility
|
OP
|
$56,510.00
|
|
|
Service Code
|
CPT 33370
|
| Hospital Charge Code |
906813370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$189.54 |
| Max. Negotiated Rate |
$50,859.00 |
| Rate for Payer: Adventist Health Commercial |
$11,302.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48,033.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,080.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42,382.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$25,429.50
|
| Rate for Payer: Cash Price |
$25,429.50
|
| Rate for Payer: Cash Price |
$25,429.50
|
| Rate for Payer: Central Health Plan Commercial |
$45,208.00
|
| Rate for Payer: Cigna of CA HMO |
$36,166.40
|
| Rate for Payer: Cigna of CA PPO |
$41,817.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48,033.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$48,033.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48,033.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39,557.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,604.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22,604.00
|
| Rate for Payer: Galaxy Health WC |
$48,033.50
|
| Rate for Payer: Global Benefits Group Commercial |
$33,906.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$50,859.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$189.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35,883.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,340.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,302.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39,557.00
|
| Rate for Payer: Multiplan Commercial |
$42,382.50
|
| Rate for Payer: Networks By Design Commercial |
$36,731.50
|
| Rate for Payer: Prime Health Services Commercial |
$48,033.50
|
| Rate for Payer: Riverside University Health System MISP |
$22,604.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33,906.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,255.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48,033.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48,033.50
|
| Rate for Payer: Vantage Medical Group Senior |
$48,033.50
|
|
