|
HC TB INTRADERMAL TEST
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
941000516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: AlphaCare 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 |
$63.15
|
| Rate for Payer: BCBS Transplant Transplant |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.08
|
| Rate for Payer: Blue Shield of California EPN |
$29.16
|
| Rate for Payer: Caremore Medicare Advantage |
$37.20
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: IEHP medi-cal |
$61.38
|
| Rate for Payer: IEHP Medicare Advantage |
$37.20
|
| Rate for Payer: Innovage PACE Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: Riverside University Health MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| 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: 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
OP
|
$60.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.74
|
| Rate for Payer: Blue Shield of California EPN |
$29.34
|
| Rate for Payer: Caremore Medicare Advantage |
$37.20
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: IEHP medi-cal |
$61.38
|
| Rate for Payer: IEHP Medicare Advantage |
$37.20
|
| Rate for Payer: Innovage PACE Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: Riverside University Health MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.00
|
| Rate for Payer: United Healthcare All Other HMO |
$30.00
|
| Rate for Payer: United Healthcare HMO Rider |
$30.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.00
|
| 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
OP
|
$60.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: AlphaCare 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 |
$63.15
|
| Rate for Payer: BCBS Transplant Transplant |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.08
|
| Rate for Payer: Blue Shield of California EPN |
$29.16
|
| Rate for Payer: Caremore Medicare Advantage |
$37.20
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: IEHP medi-cal |
$61.38
|
| Rate for Payer: IEHP Medicare Advantage |
$37.20
|
| Rate for Payer: Innovage PACE Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: Riverside University Health MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| 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: 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
|
$60.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
943100516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC TB INTRADERMAL TEST
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
943100516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: AlphaCare 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 |
$63.15
|
| Rate for Payer: BCBS Transplant Transplant |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.08
|
| Rate for Payer: Blue Shield of California EPN |
$29.16
|
| Rate for Payer: Caremore Medicare Advantage |
$37.20
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: IEHP medi-cal |
$61.38
|
| Rate for Payer: IEHP Medicare Advantage |
$37.20
|
| Rate for Payer: Innovage PACE Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: Riverside University Health MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| 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: 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
|
$60.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
949000516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC TB INTRADERMAL TEST
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC TB INTRADERMAL TEST
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$4,574.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,960.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,960.10
|
| Rate for Payer: BCBS Transplant Transplant |
$3,229.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,385.28
|
| Rate for Payer: Blue Shield of California EPN |
$2,631.80
|
| Rate for Payer: Cash Price |
$2,421.90
|
| 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: EPIC Health Plan Commercial |
$2,152.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$4,036.50
|
| Rate for Payer: IEHP medi-cal |
$1,883.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,589.79
|
| 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
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$4,574.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,574.70
|
|
|
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: Blue Shield of California Commercial |
$4,036.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,873.99
|
| Rate for Payer: Cash Price |
$2,421.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$3,589.79
|
| 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 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: AlphaCare Medical Group Commercial/Exchange |
$1,439.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$931.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$931.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$701.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$767.91
|
| Rate for Payer: BCBS Transplant Transplant |
$1,015.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,064.90
|
| Rate for Payer: Blue Shield of California EPN |
$827.88
|
| 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 |
$1,439.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$677.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,269.75
|
| Rate for Payer: IEHP medi-cal |
$592.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,129.23
|
| 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: Riverside University Health MISP |
$677.20
|
| 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 |
$846.50
|
| Rate for Payer: United Healthcare All Other HMO |
$846.50
|
| Rate for Payer: United Healthcare HMO Rider |
$846.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$846.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,439.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,439.05
|
|
|
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: Blue Shield of California Commercial |
$1,269.75
|
| Rate for Payer: Blue Shield of California EPN |
$904.06
|
| 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: EPIC Health Plan Commercial |
$677.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$1,129.23
|
| 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
|
|
|
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: Blue Shield of California Commercial |
$2,347.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,671.42
|
| 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: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$2,087.71
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$2,660.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,721.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,721.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,546.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,692.90
|
| Rate for Payer: BCBS Transplant Transplant |
$1,878.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,968.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,530.57
|
| 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: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,347.50
|
| Rate for Payer: IEHP medi-cal |
$1,095.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,087.71
|
| 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: Riverside University Health 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 |
$1,565.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,565.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,565.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,565.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,660.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,660.50
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$217.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$140.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$140.80
|
| Rate for Payer: BCBS Transplant Transplant |
$153.60
|
| Rate for Payer: Blue Shield of California Commercial |
$161.02
|
| Rate for Payer: Blue Shield of California EPN |
$125.18
|
| Rate for Payer: Cash Price |
$115.20
|
| 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: EPIC Health Plan Commercial |
$102.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$192.00
|
| Rate for Payer: IEHP medi-cal |
$89.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.75
|
| 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: Riverside University Health 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 |
$128.00
|
| Rate for Payer: United Healthcare All Other HMO |
$128.00
|
| Rate for Payer: United Healthcare HMO Rider |
$128.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$128.00
|
| 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: Blue Shield of California Commercial |
$192.00
|
| Rate for Payer: Blue Shield of California EPN |
$136.70
|
| 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: EPIC Health Plan Commercial |
$102.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$170.75
|
| 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
|
|
|
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: Blue Shield of California Commercial |
$336.75
|
| Rate for Payer: Blue Shield of California EPN |
$239.77
|
| 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: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$299.48
|
| 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
|
|
|
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 |
$89.80 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$246.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.35
|
| Rate for Payer: BCBS Transplant Transplant |
$269.40
|
| Rate for Payer: Blue Shield of California Commercial |
$282.42
|
| Rate for Payer: Blue Shield of California EPN |
$219.56
|
| 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: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$336.75
|
| Rate for Payer: IEHP medi-cal |
$157.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| 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: Riverside University Health 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 |
$224.50
|
| Rate for Payer: United Healthcare All Other HMO |
$224.50
|
| Rate for Payer: United Healthcare HMO Rider |
$224.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.50
|
| 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: Blue Shield of California Commercial |
$220.50
|
| Rate for Payer: Blue Shield of California EPN |
$157.00
|
| 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: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$196.10
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$161.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.20
|
| Rate for Payer: BCBS Transplant Transplant |
$176.40
|
| Rate for Payer: Blue Shield of California Commercial |
$184.93
|
| Rate for Payer: Blue Shield of California EPN |
$143.77
|
| 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: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$220.50
|
| Rate for Payer: IEHP medi-cal |
$102.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| 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: Riverside University Health 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 |
$147.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.00
|
| Rate for Payer: United Healthcare HMO Rider |
$147.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.00
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$1,643.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,063.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,063.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$824.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$902.88
|
| Rate for Payer: BCBS Transplant Transplant |
$1,159.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,215.86
|
| Rate for Payer: Blue Shield of California EPN |
$945.24
|
| 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: EPIC Health Plan Commercial |
$773.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,449.75
|
| Rate for Payer: IEHP medi-cal |
$676.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,289.31
|
| 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: Riverside University Health 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 |
$966.50
|
| Rate for Payer: United Healthcare All Other HMO |
$966.50
|
| Rate for Payer: United Healthcare HMO Rider |
$966.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$966.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,643.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,643.05
|
|
|
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: Blue Shield of California Commercial |
$1,449.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,032.22
|
| 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: EPIC Health Plan Commercial |
$773.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$1,289.31
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$2,038.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,318.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,318.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,392.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,524.86
|
| Rate for Payer: BCBS Transplant Transplant |
$1,438.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,508.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,172.62
|
| 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: EPIC Health Plan Commercial |
$959.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,798.50
|
| Rate for Payer: IEHP medi-cal |
$839.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,599.47
|
| 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: Riverside University Health 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 |
$1,199.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,199.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,199.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,199.00
|
| 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: Blue Shield of California Commercial |
$1,798.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,280.53
|
| 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: EPIC Health Plan Commercial |
$959.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$1,599.47
|
| 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
|
|
|
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 |
$109.11 |
| Max. Negotiated Rate |
$977.40 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$923.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$597.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$597.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.46
|
| Rate for Payer: BCBS Transplant Transplant |
$651.60
|
| Rate for Payer: Blue Shield of California Commercial |
$683.09
|
| Rate for Payer: Blue Shield of California EPN |
$531.05
|
| 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: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$814.50
|
| Rate for Payer: IEHP medi-cal |
$380.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| 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: Riverside University Health 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 |
$543.00
|
| Rate for Payer: United Healthcare All Other HMO |
$543.00
|
| Rate for Payer: United Healthcare HMO Rider |
$543.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$543.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.10
|
| Rate for Payer: Vantage Medical Group Senior |
$923.10
|
|
