|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$339,097.50
|
|
|
Service Code
|
MSDRG 652
|
| Min. Negotiated Rate |
$45,443.00 |
| Max. Negotiated Rate |
$339,097.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$120,250.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84,997.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54,904.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76,868.56
|
| Rate for Payer: CareMore Health Medicare Advantage |
$45,443.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$74,980.95
|
| Rate for Payer: EPIC Health Plan Senior |
$49,987.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$339,097.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$70,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$63,280.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$45,443.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63,620.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60,893.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$127,250.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$45,443.00
|
| Rate for Payer: Prime Health Services Medicare |
$48,169.58
|
|
|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$97,257.18
|
|
|
Service Code
|
APR-DRG 4403
|
| Min. Negotiated Rate |
$61,425.59 |
| Max. Negotiated Rate |
$97,257.18 |
| Rate for Payer: Adventist Health Medi-Cal |
$61,425.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73,198.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97,257.18
|
|
|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$76,694.32
|
|
|
Service Code
|
APR-DRG 4401
|
| Min. Negotiated Rate |
$48,438.52 |
| Max. Negotiated Rate |
$76,694.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$48,438.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57,722.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76,694.32
|
|
|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$146,103.29
|
|
|
Service Code
|
APR-DRG 4404
|
| Min. Negotiated Rate |
$92,275.76 |
| Max. Negotiated Rate |
$146,103.29 |
| Rate for Payer: Adventist Health Medi-Cal |
$92,275.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109,961.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146,103.29
|
|
|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$83,947.41
|
|
|
Service Code
|
APR-DRG 4402
|
| Min. Negotiated Rate |
$53,019.42 |
| Max. Negotiated Rate |
$83,947.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$53,019.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63,181.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83,947.41
|
|
|
Kidney Transplant - Cadaveric
|
Facility
|
IP
|
$219,330.00
|
|
|
Service Code
|
MSDRG 651
|
| Min. Negotiated Rate |
$70,887.00 |
| Max. Negotiated Rate |
$219,330.00 |
| Rate for Payer: Blue Distinction Transplant |
$219,330.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal |
$70,887.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70,887.00
|
|
|
Kidney Transplant - Cadaveric
|
Facility
|
IP
|
$219,330.00
|
|
|
Service Code
|
MSDRG 650
|
| Min. Negotiated Rate |
$70,887.00 |
| Max. Negotiated Rate |
$219,330.00 |
| Rate for Payer: Blue Distinction Transplant |
$219,330.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal |
$70,887.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70,887.00
|
|
|
Kidney Transplant - Cadaveric
|
Facility
|
IP
|
$219,330.00
|
|
|
Service Code
|
MSDRG 652
|
| Min. Negotiated Rate |
$70,887.00 |
| Max. Negotiated Rate |
$219,330.00 |
| Rate for Payer: Blue Distinction Transplant |
$219,330.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal |
$70,887.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70,887.00
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC
|
Facility
|
IP
|
$127,250.00
|
|
|
Service Code
|
MSDRG 650
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$127,250.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$120,250.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123,736.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79,928.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111,902.72
|
| Rate for Payer: CareMore Health Medicare Advantage |
$65,743.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108,476.82
|
| Rate for Payer: EPIC Health Plan Senior |
$72,317.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$70,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$63,280.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,743.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92,040.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$88,096.33
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$127,250.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$65,743.53
|
| Rate for Payer: Prime Health Services Medicare |
$69,688.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC
|
Facility
|
IP
|
$127,250.00
|
|
|
Service Code
|
MSDRG 651
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$127,250.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$120,250.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97,532.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63,002.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88,205.45
|
| Rate for Payer: CareMore Health Medicare Advantage |
$52,012.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$85,820.10
|
| Rate for Payer: EPIC Health Plan Senior |
$57,213.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$70,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$63,280.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$52,012.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$72,817.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$69,696.32
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$127,250.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$52,012.18
|
| Rate for Payer: Prime Health Services Medicare |
$55,132.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
KIT FOR PREPARATION OF GA-68-GOZETOTIDE 25 MCG INTRAVENOUS SOLUTION [233443]
|
Facility
|
IP
|
$1,326.00
|
|
|
Service Code
|
HCPCS A9616
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Adventist Health Commercial |
$265.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,063.45
|
| Rate for Payer: Blue Shield of California EPN |
$668.30
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,060.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$928.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.40
|
| Rate for Payer: EPIC Health Plan Senior |
$530.40
|
| Rate for Payer: Galaxy Health WC |
$1,127.10
|
| Rate for Payer: Global Benefits Group Commercial |
$795.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,193.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$842.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$782.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Multiplan Commercial |
$994.50
|
| Rate for Payer: Networks By Design Commercial |
$861.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,127.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$497.65
|
| Rate for Payer: United Healthcare All Other HMO |
$484.39
|
| Rate for Payer: United Healthcare HMO Rider |
$473.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.26
|
|
|
KIT FOR PREPARATION OF GA-68-GOZETOTIDE 25 MCG INTRAVENOUS SOLUTION [233443]
|
Facility
|
OP
|
$1,326.00
|
|
|
Service Code
|
HCPCS A9616
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$2,729.07 |
| Rate for Payer: Adventist Health Commercial |
$265.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,171.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$805.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,756.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,288.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,171.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,186.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,729.07
|
| Rate for Payer: Blue Shield of California Commercial |
$835.38
|
| Rate for Payer: Blue Shield of California EPN |
$526.42
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,060.80
|
| Rate for Payer: Cigna of CA HMO |
$848.64
|
| Rate for Payer: Cigna of CA PPO |
$981.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,756.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,288.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,171.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$928.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,932.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1,288.43
|
| Rate for Payer: Galaxy Health WC |
$1,127.10
|
| Rate for Payer: Global Benefits Group Commercial |
$795.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,193.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,920.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,171.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$842.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,639.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,569.54
|
| Rate for Payer: Multiplan Commercial |
$994.50
|
| Rate for Payer: Networks By Design Commercial |
$861.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,171.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,127.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,241.58
|
| Rate for Payer: Riverside University Health System MISP |
$1,288.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$795.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$795.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$497.65
|
| Rate for Payer: United Healthcare All Other HMO |
$484.39
|
| Rate for Payer: United Healthcare HMO Rider |
$473.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,171.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,756.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,288.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1,171.30
|
|
|
KIT FOR PREPARATION OF TC 99M-ALBUMIN 2.5 MG INTRAVENOUS SOLUTION [153474]
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$28.87
|
| Rate for Payer: Blue Shield of California EPN |
$18.14
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
|
|
KIT FOR PREPARATION OF TC 99M-ALBUMIN 2.5 MG INTRAVENOUS SOLUTION [153474]
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.23
|
| Rate for Payer: Blue Shield of California Commercial |
$22.68
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
KIT FOR PREPARATION OF TC-99M-EXAMETAZIME 0.5 MG INTRAVENOUS KIT [153476]
|
Facility
|
IP
|
$2,227.68
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$445.54 |
| Max. Negotiated Rate |
$2,004.91 |
| Rate for Payer: Adventist Health Commercial |
$445.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,786.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,122.75
|
| Rate for Payer: Cash Price |
$1,002.46
|
| Rate for Payer: Central Health Plan Commercial |
$1,782.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,559.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$891.07
|
| Rate for Payer: EPIC Health Plan Senior |
$891.07
|
| Rate for Payer: Galaxy Health WC |
$1,893.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1,336.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,004.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,414.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,314.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.54
|
| Rate for Payer: Multiplan Commercial |
$1,670.76
|
| Rate for Payer: Networks By Design Commercial |
$1,447.99
|
| Rate for Payer: Prime Health Services Commercial |
$1,893.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$836.05
|
| Rate for Payer: United Healthcare All Other HMO |
$813.77
|
| Rate for Payer: United Healthcare HMO Rider |
$796.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$729.57
|
|
|
KIT FOR PREPARATION OF TC-99M-EXAMETAZIME 0.5 MG INTRAVENOUS KIT [153476]
|
Facility
|
OP
|
$2,227.68
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$445.54 |
| Max. Negotiated Rate |
$2,004.91 |
| Rate for Payer: Adventist Health Commercial |
$445.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,893.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,225.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,670.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,546.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,929.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,403.44
|
| Rate for Payer: Blue Shield of California EPN |
$884.39
|
| Rate for Payer: Cash Price |
$1,002.46
|
| Rate for Payer: Cash Price |
$1,002.46
|
| Rate for Payer: Central Health Plan Commercial |
$1,782.14
|
| Rate for Payer: Cigna of CA HMO |
$1,425.72
|
| Rate for Payer: Cigna of CA PPO |
$1,648.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,893.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,893.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,893.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,559.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$891.07
|
| Rate for Payer: EPIC Health Plan Senior |
$891.07
|
| Rate for Payer: Galaxy Health WC |
$1,893.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1,336.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,004.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$781.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,414.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$862.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,314.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,559.38
|
| Rate for Payer: Multiplan Commercial |
$1,670.76
|
| Rate for Payer: Networks By Design Commercial |
$1,447.99
|
| Rate for Payer: Prime Health Services Commercial |
$1,893.53
|
| Rate for Payer: Riverside University Health System MISP |
$891.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,336.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,336.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$836.05
|
| Rate for Payer: United Healthcare All Other HMO |
$813.77
|
| Rate for Payer: United Healthcare HMO Rider |
$796.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$729.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,893.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,893.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,893.53
|
|
|
KIT FOR PREPARATION OF TC-99M-EXAMETAZIME 0.5 MG INTRAVENOUS SOLUTION [224767]
|
Facility
|
IP
|
$2,056.76
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$411.35 |
| Max. Negotiated Rate |
$1,851.08 |
| Rate for Payer: Adventist Health Commercial |
$411.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,649.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,036.61
|
| Rate for Payer: Cash Price |
$925.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,645.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,439.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$822.70
|
| Rate for Payer: EPIC Health Plan Senior |
$822.70
|
| Rate for Payer: Galaxy Health WC |
$1,748.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,234.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,851.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,306.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,213.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.35
|
| Rate for Payer: Multiplan Commercial |
$1,542.57
|
| Rate for Payer: Networks By Design Commercial |
$1,336.89
|
| Rate for Payer: Prime Health Services Commercial |
$1,748.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$771.90
|
| Rate for Payer: United Healthcare All Other HMO |
$751.33
|
| Rate for Payer: United Healthcare HMO Rider |
$735.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$673.59
|
|
|
KIT FOR PREPARATION OF TC-99M-EXAMETAZIME 0.5 MG INTRAVENOUS SOLUTION [224767]
|
Facility
|
OP
|
$2,056.76
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$411.35 |
| Max. Negotiated Rate |
$2,560.00 |
| Rate for Payer: Adventist Health Commercial |
$411.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$934.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,167.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,027.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,051.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,560.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,295.76
|
| Rate for Payer: Blue Shield of California EPN |
$816.53
|
| Rate for Payer: Cash Price |
$925.54
|
| Rate for Payer: Cash Price |
$925.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,645.41
|
| Rate for Payer: Cigna of CA HMO |
$1,316.33
|
| Rate for Payer: Cigna of CA PPO |
$1,522.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,167.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,027.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,027.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,439.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.31
|
| Rate for Payer: EPIC Health Plan Senior |
$1,027.54
|
| Rate for Payer: Galaxy Health WC |
$1,748.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,234.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,851.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,531.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$934.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,306.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,307.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,251.73
|
| Rate for Payer: Multiplan Commercial |
$1,542.57
|
| Rate for Payer: Networks By Design Commercial |
$1,336.89
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$934.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,748.25
|
| Rate for Payer: Prime Health Services Medicare |
$990.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,027.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,234.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,234.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$771.90
|
| Rate for Payer: United Healthcare All Other HMO |
$751.33
|
| Rate for Payer: United Healthcare HMO Rider |
$735.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$673.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$934.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,167.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,027.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1,027.54
|
|
|
KIT FOR PREPARATION OF TC-99M-MEDRONATE SODIUM 25 MG IV SOLUTION [121677]
|
Facility
|
IP
|
$15.60
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$14.04 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Blue Shield of California Commercial |
$12.51
|
| Rate for Payer: Blue Shield of California EPN |
$7.86
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Central Health Plan Commercial |
$12.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.24
|
| Rate for Payer: EPIC Health Plan Senior |
$6.24
|
| Rate for Payer: Galaxy Health WC |
$13.26
|
| Rate for Payer: Global Benefits Group Commercial |
$9.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$11.70
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$13.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.11
|
|
|
KIT FOR PREPARATION OF TC-99M-MEDRONATE SODIUM 25 MG IV SOLUTION [121677]
|
Facility
|
OP
|
$15.60
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$267.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.17
|
| Rate for Payer: Blue Shield of California Commercial |
$9.83
|
| Rate for Payer: Blue Shield of California EPN |
$6.19
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Central Health Plan Commercial |
$12.48
|
| Rate for Payer: Cigna of CA HMO |
$9.98
|
| Rate for Payer: Cigna of CA PPO |
$11.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.24
|
| Rate for Payer: EPIC Health Plan Senior |
$6.24
|
| Rate for Payer: Galaxy Health WC |
$13.26
|
| Rate for Payer: Global Benefits Group Commercial |
$9.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.92
|
| Rate for Payer: Multiplan Commercial |
$11.70
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$13.26
|
| Rate for Payer: Riverside University Health System MISP |
$6.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$13.26
|
|
|
KIT FOR PREPARATION OF TC 99M-SODIUM THIOSULFATE 2 MG SOLUTION [121541]
|
Facility
|
IP
|
$11.98
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9.61
|
| Rate for Payer: Blue Shield of California EPN |
$6.04
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Central Health Plan Commercial |
$9.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.79
|
| Rate for Payer: EPIC Health Plan Senior |
$4.79
|
| Rate for Payer: Galaxy Health WC |
$10.18
|
| Rate for Payer: Global Benefits Group Commercial |
$7.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.79
|
| Rate for Payer: Prime Health Services Commercial |
$10.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.92
|
|
|
KIT FOR PREPARATION OF TC 99M-SODIUM THIOSULFATE 2 MG SOLUTION [121541]
|
Facility
|
OP
|
$11.98
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$121.66 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7.55
|
| Rate for Payer: Blue Shield of California EPN |
$4.76
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Central Health Plan Commercial |
$9.58
|
| Rate for Payer: Cigna of CA HMO |
$7.67
|
| Rate for Payer: Cigna of CA PPO |
$8.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.79
|
| Rate for Payer: EPIC Health Plan Senior |
$4.79
|
| Rate for Payer: Galaxy Health WC |
$10.18
|
| Rate for Payer: Global Benefits Group Commercial |
$7.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.39
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.79
|
| Rate for Payer: Prime Health Services Commercial |
$10.18
|
| Rate for Payer: Riverside University Health System MISP |
$4.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.18
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
KIT FOR PREP TC-99M-MERTIATIDE (BETIATIDE) 1 MG INTRAVENOUS SOLUTION [225273]
|
Facility
|
OP
|
$498.77
|
|
|
Service Code
|
HCPCS A9562
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$1,018.79 |
| Rate for Payer: Adventist Health Commercial |
$99.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$423.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$274.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$374.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$816.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,018.79
|
| Rate for Payer: Blue Shield of California Commercial |
$314.23
|
| Rate for Payer: Blue Shield of California EPN |
$198.01
|
| Rate for Payer: Cash Price |
$224.45
|
| Rate for Payer: Cash Price |
$224.45
|
| Rate for Payer: Central Health Plan Commercial |
$399.02
|
| Rate for Payer: Cigna of CA HMO |
$319.21
|
| Rate for Payer: Cigna of CA PPO |
$369.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$423.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$423.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$423.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$349.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.51
|
| Rate for Payer: EPIC Health Plan Senior |
$199.51
|
| Rate for Payer: Galaxy Health WC |
$423.95
|
| Rate for Payer: Global Benefits Group Commercial |
$299.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$448.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$528.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$583.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$349.14
|
| Rate for Payer: Multiplan Commercial |
$374.08
|
| Rate for Payer: Networks By Design Commercial |
$324.20
|
| Rate for Payer: Prime Health Services Commercial |
$423.95
|
| Rate for Payer: Riverside University Health System MISP |
$199.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.19
|
| Rate for Payer: United Healthcare All Other HMO |
$182.20
|
| Rate for Payer: United Healthcare HMO Rider |
$178.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$423.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$423.95
|
| Rate for Payer: Vantage Medical Group Senior |
$423.95
|
|
|
KIT FOR PREP TC-99M-MERTIATIDE (BETIATIDE) 1 MG INTRAVENOUS SOLUTION [225273]
|
Facility
|
IP
|
$498.77
|
|
|
Service Code
|
HCPCS A9562
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$448.89 |
| Rate for Payer: Adventist Health Commercial |
$99.75
|
| Rate for Payer: Blue Shield of California Commercial |
$400.01
|
| Rate for Payer: Blue Shield of California EPN |
$251.38
|
| Rate for Payer: Cash Price |
$224.45
|
| Rate for Payer: Central Health Plan Commercial |
$399.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$349.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.51
|
| Rate for Payer: EPIC Health Plan Senior |
$199.51
|
| Rate for Payer: Galaxy Health WC |
$423.95
|
| Rate for Payer: Global Benefits Group Commercial |
$299.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$448.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$374.08
|
| Rate for Payer: Networks By Design Commercial |
$324.20
|
| Rate for Payer: Prime Health Services Commercial |
$423.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.19
|
| Rate for Payer: United Healthcare All Other HMO |
$182.20
|
| Rate for Payer: United Healthcare HMO Rider |
$178.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.35
|
|
|
KIT FOR TC 99M-LABELED RED BLOOD CELLS INTRAVENOUS SOLUTION [225270]
|
Facility
|
OP
|
$181.13
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$36.23 |
| Max. Negotiated Rate |
$260.70 |
| Rate for Payer: Adventist Health Commercial |
$36.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$208.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.70
|
| Rate for Payer: Blue Shield of California Commercial |
$114.11
|
| Rate for Payer: Blue Shield of California EPN |
$71.91
|
| Rate for Payer: Cash Price |
$81.51
|
| Rate for Payer: Cash Price |
$81.51
|
| Rate for Payer: Central Health Plan Commercial |
$144.90
|
| Rate for Payer: Cigna of CA HMO |
$115.92
|
| Rate for Payer: Cigna of CA PPO |
$134.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.45
|
| Rate for Payer: EPIC Health Plan Senior |
$72.45
|
| Rate for Payer: Galaxy Health WC |
$153.96
|
| Rate for Payer: Global Benefits Group Commercial |
$108.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$126.79
|
| Rate for Payer: Multiplan Commercial |
$135.85
|
| Rate for Payer: Networks By Design Commercial |
$117.73
|
| Rate for Payer: Prime Health Services Commercial |
$153.96
|
| Rate for Payer: Riverside University Health System MISP |
$72.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.98
|
| Rate for Payer: United Healthcare All Other HMO |
$66.17
|
| Rate for Payer: United Healthcare HMO Rider |
$64.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.96
|
| Rate for Payer: Vantage Medical Group Senior |
$153.96
|
|
