|
HC TC-99 MEBROFEN/CHOLETEC LT 15MCI
|
Facility
IP
|
$1,086.00
|
|
|
Service Code
|
CPT A9537
|
| Hospital Charge Code |
909301537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$977.40 |
| Rate for Payer: Blue Shield of California Commercial |
$814.50
|
| Rate for Payer: Blue Shield of California EPN |
$579.92
|
| 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: 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: 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
|
|
|
HC TC-99 MEDRONATE/MDP LT 30MCI
|
Facility
IP
|
$294.00
|
|
|
Service Code
|
CPT A9503
|
| Hospital Charge Code |
909301508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: 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 MEDRONATE/MDP LT 30MCI
|
Facility
OP
|
$294.00
|
|
|
Service Code
|
CPT A9503
|
| Hospital Charge Code |
909301508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$293.20 |
| 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 |
$267.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.20
|
| 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-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: AlphaCare Medical Group Commercial/Exchange |
$1,697.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,098.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,098.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$816.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$893.87
|
| Rate for Payer: BCBS Transplant Transplant |
$1,198.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,256.11
|
| Rate for Payer: Blue Shield of California EPN |
$976.53
|
| 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: EPIC Health Plan Commercial |
$798.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,497.75
|
| Rate for Payer: IEHP medi-cal |
$698.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,332.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.40
|
| Rate for Payer: Multiplan Commercial |
$1,497.75
|
| Rate for Payer: Networks By Design Commercial |
$998.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,697.45
|
| Rate for Payer: Riverside University Health 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 |
$998.50
|
| Rate for Payer: United Healthcare All Other HMO |
$998.50
|
| Rate for Payer: United Healthcare HMO Rider |
$998.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$998.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,697.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,697.45
|
|
|
HC TC-99 MERTIATIDE/MAG3 LT 15MCI
|
Facility
IP
|
$1,997.00
|
|
|
Service Code
|
CPT A9562
|
| Hospital Charge Code |
909301531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$399.40 |
| Max. Negotiated Rate |
$1,797.30 |
| Rate for Payer: Blue Shield of California Commercial |
$1,497.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,066.40
|
| 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: EPIC Health Plan Commercial |
$798.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$798.80
|
| Rate for Payer: Galaxy Health WC |
$1,697.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,198.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,797.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,332.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.40
|
| Rate for Payer: Multiplan Commercial |
$1,497.75
|
| Rate for Payer: Networks By Design Commercial |
$998.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,697.45
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$157.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.47
|
| Rate for Payer: BCBS Transplant Transplant |
$172.20
|
| Rate for Payer: Blue Shield of California Commercial |
$180.52
|
| Rate for Payer: Blue Shield of California EPN |
$140.34
|
| 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: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$215.25
|
| Rate for Payer: IEHP medi-cal |
$100.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| 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: Riverside University Health 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 |
$143.50
|
| Rate for Payer: United Healthcare All Other HMO |
$143.50
|
| Rate for Payer: United Healthcare HMO Rider |
$143.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
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: Blue Shield of California Commercial |
$215.25
|
| Rate for Payer: Blue Shield of California EPN |
$153.26
|
| 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: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$191.43
|
| 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
|
|
|
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 |
$60.16 |
| Max. Negotiated Rate |
$369.90 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$226.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$226.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.87
|
| Rate for Payer: BCBS Transplant Transplant |
$246.60
|
| Rate for Payer: Blue Shield of California Commercial |
$258.52
|
| Rate for Payer: Blue Shield of California EPN |
$200.98
|
| 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: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$308.25
|
| Rate for Payer: IEHP medi-cal |
$143.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| 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: Riverside University Health 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 |
$205.50
|
| Rate for Payer: United Healthcare All Other HMO |
$205.50
|
| Rate for Payer: United Healthcare HMO Rider |
$205.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$349.35
|
| Rate for Payer: Vantage Medical Group Senior |
$349.35
|
|
|
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: Blue Shield of California Commercial |
$308.25
|
| Rate for Payer: Blue Shield of California EPN |
$219.47
|
| 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: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$274.14
|
| 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
|
|
|
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 |
$29.78 |
| Max. Negotiated Rate |
$932.40 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$880.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$569.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$569.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.60
|
| Rate for Payer: BCBS Transplant Transplant |
$621.60
|
| Rate for Payer: Blue Shield of California Commercial |
$651.64
|
| Rate for Payer: Blue Shield of California EPN |
$506.60
|
| 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: EPIC Health Plan Commercial |
$414.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$777.00
|
| Rate for Payer: IEHP medi-cal |
$362.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$691.01
|
| 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: Riverside University Health 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 |
$518.00
|
| Rate for Payer: United Healthcare All Other HMO |
$518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$518.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$518.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$880.60
|
| Rate for Payer: Vantage Medical Group Senior |
$880.60
|
|
|
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: Blue Shield of California Commercial |
$777.00
|
| Rate for Payer: Blue Shield of California EPN |
$553.22
|
| 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: EPIC Health Plan Commercial |
$414.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$691.01
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$521.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$337.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$337.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.56
|
| Rate for Payer: BCBS Transplant Transplant |
$368.40
|
| Rate for Payer: Blue Shield of California Commercial |
$386.21
|
| Rate for Payer: Blue Shield of California EPN |
$300.25
|
| 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: EPIC Health Plan Commercial |
$245.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$460.50
|
| Rate for Payer: IEHP medi-cal |
$214.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$409.54
|
| 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: Riverside University Health 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 |
$307.00
|
| Rate for Payer: United Healthcare All Other HMO |
$307.00
|
| Rate for Payer: United Healthcare HMO Rider |
$307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$307.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$521.90
|
| Rate for Payer: Vantage Medical Group Senior |
$521.90
|
|
|
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: Blue Shield of California Commercial |
$460.50
|
| Rate for Payer: Blue Shield of California EPN |
$327.88
|
| 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: EPIC Health Plan Commercial |
$245.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$409.54
|
| 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
|
|
|
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: Blue Shield of California Commercial |
$529.50
|
| Rate for Payer: Blue Shield of California EPN |
$377.00
|
| 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: EPIC Health Plan Commercial |
$282.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$470.90
|
| 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
|
|
|
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 |
$635.40 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$600.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$388.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$388.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$232.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.07
|
| Rate for Payer: BCBS Transplant Transplant |
$423.60
|
| Rate for Payer: Blue Shield of California Commercial |
$444.07
|
| Rate for Payer: Blue Shield of California EPN |
$345.23
|
| 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 |
$600.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$529.50
|
| Rate for Payer: IEHP medi-cal |
$247.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.90
|
| 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: Riverside University Health MISP |
$282.40
|
| 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 |
$353.00
|
| Rate for Payer: United Healthcare All Other HMO |
$353.00
|
| Rate for Payer: United Healthcare HMO Rider |
$353.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$353.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$600.10
|
| Rate for Payer: Vantage Medical Group Senior |
$600.10
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$498.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$322.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$322.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$207.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.53
|
| Rate for Payer: BCBS Transplant Transplant |
$352.20
|
| Rate for Payer: Blue Shield of California Commercial |
$369.22
|
| Rate for Payer: Blue Shield of California EPN |
$287.04
|
| 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: EPIC Health Plan Commercial |
$234.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$440.25
|
| Rate for Payer: IEHP medi-cal |
$205.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$391.53
|
| 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: Riverside University Health 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 |
$293.50
|
| Rate for Payer: United Healthcare All Other HMO |
$293.50
|
| Rate for Payer: United Healthcare HMO Rider |
$293.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$498.95
|
| Rate for Payer: Vantage Medical Group Senior |
$498.95
|
|
|
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: Blue Shield of California Commercial |
$440.25
|
| Rate for Payer: Blue Shield of California EPN |
$313.46
|
| 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: EPIC Health Plan Commercial |
$234.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$391.53
|
| 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
|
|
|
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: Blue Shield of California Commercial |
$604.50
|
| Rate for Payer: Blue Shield of California EPN |
$430.40
|
| 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: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$537.60
|
| 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
|
|
|
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 |
$161.20 |
| Max. Negotiated Rate |
$725.40 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$443.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$443.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$208.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$228.73
|
| Rate for Payer: BCBS Transplant Transplant |
$483.60
|
| Rate for Payer: Blue Shield of California Commercial |
$506.97
|
| Rate for Payer: Blue Shield of California EPN |
$394.13
|
| 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: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$604.50
|
| Rate for Payer: IEHP medi-cal |
$282.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$537.60
|
| 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: Riverside University Health 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 |
$403.00
|
| Rate for Payer: United Healthcare All Other HMO |
$403.00
|
| Rate for Payer: United Healthcare HMO Rider |
$403.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$403.00
|
| 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
|
$14,072.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
906811644
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,814.40 |
| Max. Negotiated Rate |
$12,664.80 |
| Rate for Payer: Cash Price |
$6,332.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,628.80
|
| Rate for Payer: Galaxy Health WC |
$11,961.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,443.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,664.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,386.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,814.40
|
| Rate for Payer: Multiplan Commercial |
$10,554.00
|
| Rate for Payer: Networks By Design Commercial |
$9,146.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,961.20
|
|
|
HC TCATH RMVL OR DBLK ICAR MASS OR VEG
|
Facility
OP
|
$14,072.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
906811644
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,814.40 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,141.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,121.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,813.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,313.74
|
| Rate for Payer: BCBS Transplant Transplant |
$8,443.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$7,141.35
|
| Rate for Payer: Cash Price |
$6,332.40
|
| Rate for Payer: Cash Price |
$6,332.40
|
| Rate for Payer: Cash Price |
$6,332.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,257.60
|
| Rate for Payer: Cigna of CA PPO |
$10,413.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$11,961.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,443.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,664.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,554.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,711.81
|
| Rate for Payer: IEHP medi-cal |
$11,783.23
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Innovage PACE Commercial |
$10,712.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,386.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,814.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,569.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$10,554.00
|
| Rate for Payer: Networks By Design Commercial |
$9,146.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,961.20
|
| Rate for Payer: Prime Health Services Medicare |
$7,569.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,443.20
|
| Rate for Payer: Riverside University Health MISP |
$7,855.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,443.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,443.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC TCATH RMVL OR DBLK ICAR MASS OR VEG
|
Facility
IP
|
$14,072.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
906820292
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,814.40 |
| Max. Negotiated Rate |
$12,664.80 |
| Rate for Payer: Cash Price |
$6,332.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,628.80
|
| Rate for Payer: Galaxy Health WC |
$11,961.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,443.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,664.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,386.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,814.40
|
| Rate for Payer: Multiplan Commercial |
$10,554.00
|
| Rate for Payer: Networks By Design Commercial |
$9,146.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,961.20
|
|
|
HC TCATH RMVL OR DBLK ICAR MASS OR VEG
|
Facility
OP
|
$14,072.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
906820292
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,814.40 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,141.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,121.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,813.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,313.74
|
| Rate for Payer: BCBS Transplant Transplant |
$8,443.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$7,141.35
|
| Rate for Payer: Cash Price |
$6,332.40
|
| Rate for Payer: Cash Price |
$6,332.40
|
| Rate for Payer: Cash Price |
$6,332.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,257.60
|
| Rate for Payer: Cigna of CA PPO |
$10,413.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$11,961.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,443.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,664.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,554.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,711.81
|
| Rate for Payer: IEHP medi-cal |
$11,783.23
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Innovage PACE Commercial |
$10,712.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,386.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,814.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,569.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$10,554.00
|
| Rate for Payer: Networks By Design Commercial |
$9,146.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,961.20
|
| Rate for Payer: Prime Health Services Medicare |
$7,569.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,443.20
|
| Rate for Payer: Riverside University Health MISP |
$7,855.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,443.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,443.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC TCAT IMPL WRLS PUL ART PRS SNR
|
Facility
OP
|
$21,934.00
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
906820143
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$724.00 |
| Max. Negotiated Rate |
$59,918.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$36,314.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,989.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$54,471.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39,945.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36,314.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: BCBS Transplant Transplant |
$13,160.40
|
| Rate for Payer: Blue Shield of California Commercial |
$13,555.21
|
| Rate for Payer: Blue Shield of California EPN |
$10,659.92
|
| Rate for Payer: Caremore Medicare Advantage |
$36,314.24
|
| Rate for Payer: Cash Price |
$9,870.30
|
| Rate for Payer: Cash Price |
$9,870.30
|
| Rate for Payer: Cash Price |
$9,870.30
|
| Rate for Payer: Central Health Plan Commercial |
$17,547.20
|
| Rate for Payer: Cigna of CA HMO |
$14,037.76
|
| Rate for Payer: Cigna of CA PPO |
$16,231.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54,471.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,024.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36,314.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$36,314.24
|
| Rate for Payer: Galaxy Health WC |
$18,643.90
|
| Rate for Payer: Global Benefits Group Commercial |
$13,160.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,740.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16,450.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$59,555.35
|
| Rate for Payer: IEHP medi-cal |
$59,918.50
|
| Rate for Payer: IEHP Medicare Advantage |
$36,314.24
|
| Rate for Payer: Innovage PACE Commercial |
$54,471.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,629.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,314.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,386.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,661.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,661.08
|
| Rate for Payer: Multiplan Commercial |
$16,450.50
|
| Rate for Payer: Networks By Design Commercial |
$14,257.10
|
| Rate for Payer: Prime Health Services Commercial |
$18,643.90
|
| Rate for Payer: Prime Health Services Medicare |
$38,493.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13,160.40
|
| Rate for Payer: Riverside University Health MISP |
$39,945.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,160.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,160.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54,471.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,945.66
|
| Rate for Payer: Vantage Medical Group Senior |
$36,314.24
|
|
|
HC TCAT IMPL WRLS PUL ART PRS SNR
|
Facility
OP
|
$21,934.00
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
906811492
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$724.00 |
| Max. Negotiated Rate |
$59,918.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$36,314.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,989.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$54,471.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39,945.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36,314.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: BCBS Transplant Transplant |
$13,160.40
|
| Rate for Payer: Blue Shield of California Commercial |
$13,555.21
|
| Rate for Payer: Blue Shield of California EPN |
$10,659.92
|
| Rate for Payer: Caremore Medicare Advantage |
$36,314.24
|
| Rate for Payer: Cash Price |
$9,870.30
|
| Rate for Payer: Cash Price |
$9,870.30
|
| Rate for Payer: Cash Price |
$9,870.30
|
| Rate for Payer: Central Health Plan Commercial |
$17,547.20
|
| Rate for Payer: Cigna of CA HMO |
$14,037.76
|
| Rate for Payer: Cigna of CA PPO |
$16,231.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54,471.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,024.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36,314.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$36,314.24
|
| Rate for Payer: Galaxy Health WC |
$18,643.90
|
| Rate for Payer: Global Benefits Group Commercial |
$13,160.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,740.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16,450.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$59,555.35
|
| Rate for Payer: IEHP medi-cal |
$59,918.50
|
| Rate for Payer: IEHP Medicare Advantage |
$36,314.24
|
| Rate for Payer: Innovage PACE Commercial |
$54,471.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,629.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,314.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,386.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,661.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,661.08
|
| Rate for Payer: Multiplan Commercial |
$16,450.50
|
| Rate for Payer: Networks By Design Commercial |
$14,257.10
|
| Rate for Payer: Prime Health Services Commercial |
$18,643.90
|
| Rate for Payer: Prime Health Services Medicare |
$38,493.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13,160.40
|
| Rate for Payer: Riverside University Health MISP |
$39,945.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,160.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,160.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54,471.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,945.66
|
| Rate for Payer: Vantage Medical Group Senior |
$36,314.24
|
|
