|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC TC-99 ARCITUMOMAB/CEA TO 45MCI
|
Facility
|
IP
|
$5,382.00
|
|
|
Service Code
|
CPT A9568
|
| Hospital Charge Code |
909301539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,076.40 |
| Max. Negotiated Rate |
$4,843.80 |
| Rate for Payer: Adventist Health Commercial |
$1,076.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,160.29
|
| Rate for Payer: Blue Shield of California EPN |
$2,712.53
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,152.80
|
| Rate for Payer: Galaxy Health WC |
$4,574.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,229.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,843.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,589.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,050.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,331.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.40
|
| Rate for Payer: Multiplan Commercial |
$4,036.50
|
| Rate for Payer: Networks By Design Commercial |
$3,498.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,574.70
|
|
|
HC TC-99 ARCITUMOMAB/CEA TO 45MCI
|
Facility
|
OP
|
$5,382.00
|
|
|
Service Code
|
CPT A9568
|
| Hospital Charge Code |
909301539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$809.51 |
| Max. Negotiated Rate |
$4,843.80 |
| Rate for Payer: Adventist Health Commercial |
$1,076.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$809.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$890.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$890.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,605.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,160.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3,288.40
|
| Rate for Payer: Blue Shield of California EPN |
$2,147.42
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| 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 |
$1,011.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$890.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$890.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.84
|
| Rate for Payer: EPIC Health Plan Senior |
$809.51
|
| 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: Heritage Provider Network Commercial/Senior |
$1,327.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$809.51
|
| Rate for Payer: InnovAge PACE Commercial |
$1,214.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,589.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,050.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$809.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,084.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,084.74
|
| Rate for Payer: Multiplan Commercial |
$4,036.50
|
| Rate for Payer: Networks By Design Commercial |
$3,498.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$809.51
|
| Rate for Payer: Prime Health Services Commercial |
$4,574.70
|
| Rate for Payer: Prime Health Services Medicare |
$858.08
|
| Rate for Payer: Riverside University Health System MISP |
$890.46
|
| 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: Upland Medical Group Pediatric |
$809.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$890.46
|
| Rate for Payer: Vantage Medical Group Senior |
$890.46
|
|
|
HC TC-99 BICISTAE/NUEROLITE LT 25MCI
|
Facility
|
IP
|
$1,693.00
|
|
|
Service Code
|
CPT A9557
|
| Hospital Charge Code |
909301541
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.60 |
| Max. Negotiated Rate |
$1,523.70 |
| Rate for Payer: Adventist Health Commercial |
$338.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,308.69
|
| Rate for Payer: Blue Shield of California EPN |
$853.27
|
| Rate for Payer: Cash Price |
$931.15
|
| 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 Senior |
$677.20
|
| Rate for Payer: Galaxy Health WC |
$1,439.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,015.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,523.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,129.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$645.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,047.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.60
|
| Rate for Payer: Multiplan Commercial |
$1,269.75
|
| Rate for Payer: Networks By Design Commercial |
$846.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,439.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$635.38
|
| Rate for Payer: United Healthcare All Other HMO |
$618.45
|
| Rate for Payer: United Healthcare HMO Rider |
$605.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$554.46
|
|
|
HC TC-99 BICISTAE/NUEROLITE LT 25MCI
|
Facility
|
OP
|
$1,693.00
|
|
|
Service Code
|
CPT A9557
|
| Hospital Charge Code |
909301541
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.60 |
| Max. Negotiated Rate |
$1,523.70 |
| Rate for Payer: Adventist Health Commercial |
$338.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$683.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$854.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$752.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$819.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$994.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,034.42
|
| Rate for Payer: Blue Shield of California EPN |
$675.51
|
| Rate for Payer: Cash Price |
$931.15
|
| Rate for Payer: Cash Price |
$931.15
|
| 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 |
$854.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$752.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.13
|
| Rate for Payer: EPIC Health Plan Senior |
$683.80
|
| Rate for Payer: Galaxy Health WC |
$1,439.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,015.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,523.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,121.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$583.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.80
|
| Rate for Payer: InnovAge PACE Commercial |
$1,025.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,129.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$916.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.29
|
| Rate for Payer: Multiplan Commercial |
$1,269.75
|
| Rate for Payer: Networks By Design Commercial |
$846.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$683.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,439.05
|
| Rate for Payer: Prime Health Services Medicare |
$724.83
|
| Rate for Payer: Riverside University Health System MISP |
$752.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,015.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,015.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$635.38
|
| Rate for Payer: United Healthcare All Other HMO |
$618.45
|
| Rate for Payer: United Healthcare HMO Rider |
$605.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$554.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$854.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.18
|
| Rate for Payer: Vantage Medical Group Senior |
$752.18
|
|
|
HC TC-99 CERETEC UP TO 25 MCI
|
Facility
|
IP
|
$3,130.00
|
|
|
Service Code
|
CPT A9521
|
| Hospital Charge Code |
909301535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$626.00 |
| Max. Negotiated Rate |
$2,817.00 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,419.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,577.52
|
| Rate for Payer: Cash Price |
$1,721.50
|
| 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 Senior |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,817.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,087.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,192.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,937.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.00
|
| Rate for Payer: Multiplan Commercial |
$2,347.50
|
| Rate for Payer: Networks By Design Commercial |
$1,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,118.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,025.08
|
|
|
HC TC-99 CERETEC UP TO 25 MCI
|
Facility
|
OP
|
$3,130.00
|
|
|
Service Code
|
CPT A9521
|
| Hospital Charge Code |
909301535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$626.00 |
| Max. Negotiated Rate |
$2,817.00 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$802.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,002.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$882.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,515.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,838.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,912.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,248.87
|
| Rate for Payer: Cash Price |
$1,721.50
|
| Rate for Payer: Cash Price |
$1,721.50
|
| 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 |
$1,002.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$882.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.16
|
| Rate for Payer: EPIC Health Plan Senior |
$802.34
|
| 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: Heritage Provider Network Commercial/Senior |
$1,315.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$781.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.34
|
| Rate for Payer: InnovAge PACE Commercial |
$1,203.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,087.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$862.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.14
|
| Rate for Payer: Multiplan Commercial |
$2,347.50
|
| Rate for Payer: Networks By Design Commercial |
$1,565.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$802.34
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: Prime Health Services Medicare |
$850.48
|
| Rate for Payer: Riverside University Health System MISP |
$882.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,878.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,878.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,118.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,025.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$802.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,002.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.57
|
| Rate for Payer: Vantage Medical Group Senior |
$882.57
|
|
|
HC TC-99 GHT UP TO 25 MCI
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT A9550
|
| Hospital Charge Code |
909301509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Adventist Health Commercial |
$51.20
|
| Rate for Payer: Blue Shield of California Commercial |
$197.89
|
| Rate for Payer: Blue Shield of California EPN |
$129.02
|
| Rate for Payer: Cash Price |
$140.80
|
| 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 Senior |
$102.40
|
| Rate for Payer: Galaxy Health WC |
$217.60
|
| Rate for Payer: Global Benefits Group Commercial |
$153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.20
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Networks By Design Commercial |
$128.00
|
| Rate for Payer: Prime Health Services Commercial |
$217.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.08
|
| Rate for Payer: United Healthcare All Other HMO |
$93.52
|
| Rate for Payer: United Healthcare HMO Rider |
$91.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.84
|
|
|
HC TC-99 GHT UP TO 25 MCI
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT A9550
|
| Hospital Charge Code |
909301509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Adventist Health Commercial |
$51.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$217.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.35
|
| Rate for Payer: Blue Shield of California Commercial |
$156.42
|
| Rate for Payer: Blue Shield of California EPN |
$102.14
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Central Health Plan Commercial |
$204.80
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$179.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$217.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$217.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.40
|
| Rate for Payer: EPIC Health Plan Senior |
$102.40
|
| Rate for Payer: Galaxy Health WC |
$217.60
|
| Rate for Payer: Global Benefits Group Commercial |
$153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.40
|
| Rate for Payer: InnovAge PACE Commercial |
$128.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$179.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$179.20
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Networks By Design Commercial |
$128.00
|
| Rate for Payer: Prime Health Services Commercial |
$217.60
|
| Rate for Payer: Riverside University Health System MISP |
$102.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.08
|
| Rate for Payer: United Healthcare All Other HMO |
$93.52
|
| Rate for Payer: United Healthcare HMO Rider |
$91.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$217.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$217.60
|
| Rate for Payer: Vantage Medical Group Senior |
$217.60
|
|
|
HC TC-99 HEPATOLITE UP TO 15 MCI
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT A9510
|
| Hospital Charge Code |
909301505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$217.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.70
|
| Rate for Payer: Blue Shield of California Commercial |
$274.34
|
| Rate for Payer: Blue Shield of California EPN |
$179.15
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Central Health Plan Commercial |
$359.20
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$381.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$381.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$404.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.91
|
| Rate for Payer: InnovAge PACE Commercial |
$224.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$314.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$314.30
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Riverside University Health System MISP |
$179.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$381.65
|
| Rate for Payer: Vantage Medical Group Senior |
$381.65
|
|
|
HC TC-99 HEPATOLITE UP TO 15 MCI
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT A9510
|
| Hospital Charge Code |
909301505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Blue Shield of California Commercial |
$347.08
|
| Rate for Payer: Blue Shield of California EPN |
$226.30
|
| Rate for Payer: Cash Price |
$246.95
|
| 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 Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$404.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.80
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
|
|
HC TC-99 MAA UP TO 10 MCI
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT A9540
|
| Hospital Charge Code |
909301506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.67
|
| Rate for Payer: Blue Shield of California Commercial |
$179.63
|
| Rate for Payer: Blue Shield of California EPN |
$117.31
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Central Health Plan Commercial |
$235.20
|
| Rate for Payer: Cigna of CA HMO |
$205.80
|
| Rate for Payer: Cigna of CA PPO |
$205.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.60
|
| Rate for Payer: InnovAge PACE Commercial |
$147.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Networks By Design Commercial |
$147.00
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Riverside University Health System MISP |
$117.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.34
|
| Rate for Payer: United Healthcare All Other HMO |
$107.40
|
| Rate for Payer: United Healthcare HMO Rider |
$105.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
|
|
HC TC-99 MAA UP TO 10 MCI
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT A9540
|
| Hospital Charge Code |
909301506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Blue Shield of California Commercial |
$227.26
|
| Rate for Payer: Blue Shield of California EPN |
$148.18
|
| Rate for Payer: Cash Price |
$161.70
|
| 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 Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Networks By Design Commercial |
$147.00
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.34
|
| Rate for Payer: United Healthcare All Other HMO |
$107.40
|
| Rate for Payer: United Healthcare HMO Rider |
$105.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.28
|
|
|
HC TC-99M APCITIDE/ACCUTEC LT 20MCI
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
CPT A9504
|
| Hospital Charge Code |
909301540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$386.60 |
| Max. Negotiated Rate |
$1,739.70 |
| Rate for Payer: Adventist Health Commercial |
$386.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,643.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,063.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,449.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$935.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,135.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,181.06
|
| Rate for Payer: Blue Shield of California EPN |
$771.27
|
| Rate for Payer: Cash Price |
$1,063.15
|
| Rate for Payer: Cash Price |
$1,063.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,546.40
|
| Rate for Payer: Cigna of CA HMO |
$1,353.10
|
| Rate for Payer: Cigna of CA PPO |
$1,353.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,643.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,643.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,643.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$773.20
|
| Rate for Payer: EPIC Health Plan Senior |
$773.20
|
| Rate for Payer: Galaxy Health WC |
$1,643.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,159.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,739.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$653.60
|
| Rate for Payer: InnovAge PACE Commercial |
$966.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,289.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,196.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,353.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,353.10
|
| Rate for Payer: Multiplan Commercial |
$1,449.75
|
| Rate for Payer: Networks By Design Commercial |
$966.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,643.05
|
| Rate for Payer: Riverside University Health System MISP |
$773.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,159.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,159.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.45
|
| Rate for Payer: United Healthcare All Other HMO |
$706.12
|
| Rate for Payer: United Healthcare HMO Rider |
$690.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$633.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,643.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,643.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,643.05
|
|
|
HC TC-99M APCITIDE/ACCUTEC LT 20MCI
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
CPT A9504
|
| Hospital Charge Code |
909301540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$386.60 |
| Max. Negotiated Rate |
$1,739.70 |
| Rate for Payer: Adventist Health Commercial |
$386.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,494.21
|
| Rate for Payer: Blue Shield of California EPN |
$974.23
|
| Rate for Payer: Cash Price |
$1,063.15
|
| 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 Senior |
$773.20
|
| Rate for Payer: Galaxy Health WC |
$1,643.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,159.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,739.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,289.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$736.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,196.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.60
|
| Rate for Payer: Multiplan Commercial |
$1,449.75
|
| Rate for Payer: Networks By Design Commercial |
$966.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,643.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.45
|
| Rate for Payer: United Healthcare All Other HMO |
$706.12
|
| Rate for Payer: United Healthcare HMO Rider |
$690.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$633.06
|
|
|
HC TC-99M DEPREOTID NEOTEC LT 35MCI
|
Facility
|
IP
|
$2,398.00
|
|
|
Service Code
|
CPT A9536
|
| Hospital Charge Code |
909301542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$479.60 |
| Max. Negotiated Rate |
$2,158.20 |
| Rate for Payer: Adventist Health Commercial |
$479.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,853.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,208.59
|
| Rate for Payer: Cash Price |
$1,318.90
|
| 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 Senior |
$959.20
|
| Rate for Payer: Galaxy Health WC |
$2,038.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,438.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,158.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,599.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$913.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,484.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.60
|
| Rate for Payer: Multiplan Commercial |
$1,798.50
|
| Rate for Payer: Networks By Design Commercial |
$1,199.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,038.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$899.97
|
| Rate for Payer: United Healthcare All Other HMO |
$875.99
|
| Rate for Payer: United Healthcare HMO Rider |
$857.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$785.35
|
|
|
HC TC-99M DEPREOTID NEOTEC LT 35MCI
|
Facility
|
OP
|
$2,398.00
|
|
|
Service Code
|
CPT A9536
|
| Hospital Charge Code |
909301542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$479.60 |
| Max. Negotiated Rate |
$2,158.20 |
| Rate for Payer: Adventist Health Commercial |
$479.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,038.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,318.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,798.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,161.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,408.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,465.18
|
| Rate for Payer: Blue Shield of California EPN |
$956.80
|
| Rate for Payer: Cash Price |
$1,318.90
|
| Rate for Payer: Cash Price |
$1,318.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,918.40
|
| Rate for Payer: Cigna of CA HMO |
$1,678.60
|
| Rate for Payer: Cigna of CA PPO |
$1,678.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,038.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,038.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$959.20
|
| Rate for Payer: EPIC Health Plan Senior |
$959.20
|
| Rate for Payer: Galaxy Health WC |
$2,038.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,438.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,158.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,045.76
|
| Rate for Payer: InnovAge PACE Commercial |
$1,199.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,599.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,155.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,484.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,678.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,678.60
|
| Rate for Payer: Multiplan Commercial |
$1,798.50
|
| Rate for Payer: Networks By Design Commercial |
$1,199.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,038.30
|
| Rate for Payer: Riverside University Health System MISP |
$959.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,438.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,438.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$899.97
|
| Rate for Payer: United Healthcare All Other HMO |
$875.99
|
| Rate for Payer: United Healthcare HMO Rider |
$857.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$785.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,038.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,038.30
|
|
|
HC TC-99 MEBROFEN/CHOLETEC LT 15MCI
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT A9537
|
| Hospital Charge Code |
909301537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.02 |
| Max. Negotiated Rate |
$977.40 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$923.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$597.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$814.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$525.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$637.81
|
| Rate for Payer: Blue Shield of California Commercial |
$663.55
|
| Rate for Payer: Blue Shield of California EPN |
$433.31
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Central Health Plan Commercial |
$868.80
|
| Rate for Payer: Cigna of CA HMO |
$760.20
|
| Rate for Payer: Cigna of CA PPO |
$760.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$923.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$923.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$977.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.02
|
| Rate for Payer: InnovAge PACE Commercial |
$543.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$760.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.20
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
| Rate for Payer: Networks By Design Commercial |
$543.00
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
| Rate for Payer: Riverside University Health System MISP |
$434.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$651.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$651.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$407.58
|
| Rate for Payer: United Healthcare All Other HMO |
$396.72
|
| Rate for Payer: United Healthcare HMO Rider |
$388.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$355.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$923.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.10
|
| Rate for Payer: Vantage Medical Group Senior |
$923.10
|
|
|
HC TC-99 MEBROFEN/CHOLETEC LT 15MCI
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT A9537
|
| Hospital Charge Code |
909301537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$977.40 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Blue Shield of California Commercial |
$839.48
|
| Rate for Payer: Blue Shield of California EPN |
$547.34
|
| Rate for Payer: Cash Price |
$597.30
|
| 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 Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$977.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.20
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
| Rate for Payer: Networks By Design Commercial |
$543.00
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$407.58
|
| Rate for Payer: United Healthcare All Other HMO |
$396.72
|
| Rate for Payer: United Healthcare HMO Rider |
$388.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$355.67
|
|
|
HC TC-99 MEDRONATE/MDP LT 30MCI
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT A9503
|
| Hospital Charge Code |
909301508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Blue Shield of California Commercial |
$227.26
|
| Rate for Payer: Blue Shield of California EPN |
$148.18
|
| Rate for Payer: Cash Price |
$161.70
|
| 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 Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Networks By Design Commercial |
$147.00
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.34
|
| Rate for Payer: United Healthcare All Other HMO |
$107.40
|
| Rate for Payer: United Healthcare HMO Rider |
$105.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.28
|
|
|
HC TC-99 MEDRONATE/MDP LT 30MCI
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT A9503
|
| Hospital Charge Code |
909301508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.67
|
| Rate for Payer: Blue Shield of California Commercial |
$179.63
|
| Rate for Payer: Blue Shield of California EPN |
$117.31
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Central Health Plan Commercial |
$235.20
|
| Rate for Payer: Cigna of CA HMO |
$205.80
|
| Rate for Payer: Cigna of CA PPO |
$205.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.46
|
| Rate for Payer: InnovAge PACE Commercial |
$147.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Networks By Design Commercial |
$147.00
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Riverside University Health System MISP |
$117.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.34
|
| Rate for Payer: United Healthcare All Other HMO |
$107.40
|
| Rate for Payer: United Healthcare HMO Rider |
$105.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
|
|
HC TC-99 MERTIATIDE/MAG3 LT 15MCI
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
CPT A9562
|
| Hospital Charge Code |
909301531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$399.40 |
| Max. Negotiated Rate |
$1,797.30 |
| Rate for Payer: Adventist Health Commercial |
$399.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,697.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,098.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,497.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$966.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,172.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,220.17
|
| Rate for Payer: Blue Shield of California EPN |
$796.80
|
| Rate for Payer: Cash Price |
$1,098.35
|
| Rate for Payer: Cash Price |
$1,098.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,597.60
|
| Rate for Payer: Cigna of CA HMO |
$1,397.90
|
| Rate for Payer: Cigna of CA PPO |
$1,397.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,697.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,697.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,697.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$798.80
|
| Rate for Payer: EPIC Health Plan Senior |
$798.80
|
| Rate for Payer: Galaxy Health WC |
$1,697.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,198.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,797.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$528.01
|
| Rate for Payer: InnovAge PACE Commercial |
$998.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,332.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$583.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,236.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,397.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,397.90
|
| Rate for Payer: Multiplan Commercial |
$1,497.75
|
| Rate for Payer: Networks By Design Commercial |
$998.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,697.45
|
| Rate for Payer: Riverside University Health System MISP |
$798.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,198.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,198.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$749.47
|
| Rate for Payer: United Healthcare All Other HMO |
$729.50
|
| Rate for Payer: United Healthcare HMO Rider |
$713.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,697.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,697.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,697.45
|
|
|
HC TC-99 MERTIATIDE/MAG3 LT 15MCI
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
CPT A9562
|
| Hospital Charge Code |
909301531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$399.40 |
| Max. Negotiated Rate |
$1,797.30 |
| Rate for Payer: Adventist Health Commercial |
$399.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,543.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,006.49
|
| Rate for Payer: Cash Price |
$1,098.35
|
| 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 Senior |
$798.80
|
| Rate for Payer: Galaxy Health WC |
$1,697.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,198.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,797.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,332.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$760.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,236.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.40
|
| Rate for Payer: Multiplan Commercial |
$1,497.75
|
| Rate for Payer: Networks By Design Commercial |
$998.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,697.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$749.47
|
| Rate for Payer: United Healthcare All Other HMO |
$729.50
|
| Rate for Payer: United Healthcare HMO Rider |
$713.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.02
|
|
|
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 |
$57.40 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.56
|
| Rate for Payer: Blue Shield of California Commercial |
$175.36
|
| Rate for Payer: Blue Shield of California EPN |
$114.51
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Central Health Plan Commercial |
$229.60
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$258.30
|
| Rate for Payer: InnovAge PACE Commercial |
$143.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.90
|
| Rate for Payer: Multiplan Commercial |
$215.25
|
| Rate for Payer: Networks By Design Commercial |
$143.50
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Riverside University Health System MISP |
$114.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Other HMO |
$104.84
|
| Rate for Payer: United Healthcare HMO Rider |
$102.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
HC TC-99M PERTECHNETATE PER MCI
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT A9512
|
| Hospital Charge Code |
909301501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Blue Shield of California Commercial |
$221.85
|
| Rate for Payer: Blue Shield of California EPN |
$144.65
|
| Rate for Payer: Cash Price |
$157.85
|
| 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 Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$258.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$215.25
|
| Rate for Payer: Networks By Design Commercial |
$143.50
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Other HMO |
$104.84
|
| Rate for Payer: United Healthcare HMO Rider |
$102.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.99
|
|
