|
HC XRAY HIP W/PELVIS BI 5/GT VIEWS
|
Facility
OP
|
$1,368.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
909073523
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,231.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$341.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$416.51
|
| Rate for Payer: BCBS Transplant Transplant |
$820.80
|
| Rate for Payer: Blue Shield of California Commercial |
$845.42
|
| Rate for Payer: Blue Shield of California EPN |
$664.85
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,094.40
|
| Rate for Payer: Cigna of CA HMO |
$875.52
|
| Rate for Payer: Cigna of CA PPO |
$1,012.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,162.80
|
| Rate for Payer: Global Benefits Group Commercial |
$820.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,231.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,026.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$912.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,026.00
|
| Rate for Payer: Networks By Design Commercial |
$889.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,162.80
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$820.80
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$820.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$820.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.44
|
| Rate for Payer: United Healthcare All Other HMO |
$491.44
|
| Rate for Payer: United Healthcare HMO Rider |
$491.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY HIP W/PELVIS UNI 1 VIEW
|
Facility
OP
|
$717.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
909073501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.47 |
| Max. Negotiated Rate |
$645.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$171.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.67
|
| Rate for Payer: BCBS Transplant Transplant |
$430.20
|
| Rate for Payer: Blue Shield of California Commercial |
$443.11
|
| Rate for Payer: Blue Shield of California EPN |
$348.46
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$322.65
|
| Rate for Payer: Cash Price |
$322.65
|
| Rate for Payer: Central Health Plan Commercial |
$573.60
|
| Rate for Payer: Cigna of CA HMO |
$458.88
|
| Rate for Payer: Cigna of CA PPO |
$530.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$609.45
|
| Rate for Payer: Global Benefits Group Commercial |
$430.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$645.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$537.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$478.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$537.75
|
| Rate for Payer: Networks By Design Commercial |
$466.05
|
| Rate for Payer: Prime Health Services Commercial |
$609.45
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$430.20
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$430.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$430.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.65
|
| Rate for Payer: United Healthcare All Other HMO |
$155.65
|
| Rate for Payer: United Healthcare HMO Rider |
$155.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC XRAY HIP W/PELVIS UNI 1 VIEW
|
Facility
IP
|
$717.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
909073501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.40 |
| Max. Negotiated Rate |
$645.30 |
| Rate for Payer: Cash Price |
$322.65
|
| Rate for Payer: Central Health Plan Commercial |
$573.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.80
|
| Rate for Payer: Galaxy Health WC |
$609.45
|
| Rate for Payer: Global Benefits Group Commercial |
$430.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$645.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$478.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.40
|
| Rate for Payer: Multiplan Commercial |
$537.75
|
| Rate for Payer: Networks By Design Commercial |
$466.05
|
| Rate for Payer: Prime Health Services Commercial |
$609.45
|
|
|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
IP
|
$996.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
909073502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
|
|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
OP
|
$996.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
909073502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$253.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.80
|
| Rate for Payer: BCBS Transplant Transplant |
$597.60
|
| Rate for Payer: Blue Shield of California Commercial |
$615.53
|
| Rate for Payer: Blue Shield of California EPN |
$484.06
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Cigna of CA HMO |
$637.44
|
| Rate for Payer: Cigna of CA PPO |
$737.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$747.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$597.60
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.65
|
| Rate for Payer: United Healthcare All Other HMO |
$155.65
|
| Rate for Payer: United Healthcare HMO Rider |
$155.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC XRAY HIP W/PELVIS UNI 4 GT VIEWS
|
Facility
IP
|
$1,230.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
909073503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.00 |
| Max. Negotiated Rate |
$1,107.00 |
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Central Health Plan Commercial |
$984.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.00
|
| Rate for Payer: Galaxy Health WC |
$1,045.50
|
| Rate for Payer: Global Benefits Group Commercial |
$738.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,107.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$820.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$922.50
|
| Rate for Payer: Networks By Design Commercial |
$799.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,045.50
|
|
|
HC XRAY HIP W/PELVIS UNI 4 GT VIEWS
|
Facility
OP
|
$1,230.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
909073503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,107.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$209.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$313.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.57
|
| Rate for Payer: BCBS Transplant Transplant |
$738.00
|
| Rate for Payer: Blue Shield of California Commercial |
$760.14
|
| Rate for Payer: Blue Shield of California EPN |
$597.78
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Central Health Plan Commercial |
$984.00
|
| Rate for Payer: Cigna of CA HMO |
$787.20
|
| Rate for Payer: Cigna of CA PPO |
$910.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,045.50
|
| Rate for Payer: Global Benefits Group Commercial |
$738.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,107.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$922.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$820.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$922.50
|
| Rate for Payer: Networks By Design Commercial |
$799.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,045.50
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$738.00
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$738.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$738.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.76
|
| Rate for Payer: United Healthcare All Other HMO |
$257.76
|
| Rate for Payer: United Healthcare HMO Rider |
$257.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY SKULL RADIOGRAPH LTD
|
Facility
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
908801144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$951.30 |
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Central Health Plan Commercial |
$845.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$951.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
|
|
HC XRAY SKULL RADIOGRAPH LTD
|
Facility
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
908801144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.69 |
| Max. Negotiated Rate |
$951.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.83
|
| Rate for Payer: BCBS Transplant Transplant |
$634.20
|
| Rate for Payer: Blue Shield of California Commercial |
$653.23
|
| Rate for Payer: Blue Shield of California EPN |
$513.70
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Central Health Plan Commercial |
$845.60
|
| Rate for Payer: Cigna of CA HMO |
$676.48
|
| Rate for Payer: Cigna of CA PPO |
$782.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$951.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$792.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$634.20
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$634.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$634.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XR RIBS UNI & PA CHEST
|
Facility
OP
|
$1,117.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.69 |
| Max. Negotiated Rate |
$1,005.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.92
|
| Rate for Payer: BCBS Transplant Transplant |
$670.20
|
| Rate for Payer: Blue Shield of California Commercial |
$690.31
|
| Rate for Payer: Blue Shield of California EPN |
$542.86
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$502.65
|
| Rate for Payer: Cash Price |
$502.65
|
| Rate for Payer: Central Health Plan Commercial |
$893.60
|
| Rate for Payer: Cigna of CA HMO |
$714.88
|
| Rate for Payer: Cigna of CA PPO |
$826.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$949.45
|
| Rate for Payer: Global Benefits Group Commercial |
$670.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,005.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$837.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$837.75
|
| Rate for Payer: Networks By Design Commercial |
$726.05
|
| Rate for Payer: Prime Health Services Commercial |
$949.45
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$670.20
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XR RIBS UNI & PA CHEST
|
Facility
IP
|
$1,117.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.40 |
| Max. Negotiated Rate |
$1,005.30 |
| Rate for Payer: Cash Price |
$502.65
|
| Rate for Payer: Central Health Plan Commercial |
$893.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.80
|
| Rate for Payer: Galaxy Health WC |
$949.45
|
| Rate for Payer: Global Benefits Group Commercial |
$670.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,005.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.40
|
| Rate for Payer: Multiplan Commercial |
$837.75
|
| Rate for Payer: Networks By Design Commercial |
$726.05
|
| Rate for Payer: Prime Health Services Commercial |
$949.45
|
|
|
HC XR RIBS W PA CXR
|
Facility
OP
|
$1,421.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,278.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$209.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$186.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.31
|
| Rate for Payer: BCBS Transplant Transplant |
$852.60
|
| Rate for Payer: Blue Shield of California Commercial |
$878.18
|
| Rate for Payer: Blue Shield of California EPN |
$690.61
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$639.45
|
| Rate for Payer: Cash Price |
$639.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.80
|
| Rate for Payer: Cigna of CA HMO |
$909.44
|
| Rate for Payer: Cigna of CA PPO |
$1,051.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,207.85
|
| Rate for Payer: Global Benefits Group Commercial |
$852.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,065.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,065.75
|
| Rate for Payer: Networks By Design Commercial |
$923.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.85
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$852.60
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$852.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$852.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XR RIBS W PA CXR
|
Facility
IP
|
$1,421.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$1,278.90 |
| Rate for Payer: Cash Price |
$639.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.40
|
| Rate for Payer: Galaxy Health WC |
$1,207.85
|
| Rate for Payer: Global Benefits Group Commercial |
$852.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.20
|
| Rate for Payer: Multiplan Commercial |
$1,065.75
|
| Rate for Payer: Networks By Design Commercial |
$923.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.85
|
|
|
HC XR TEMP MANDIBULAR BILAT
|
Facility
OP
|
$1,024.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
909020170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$921.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$173.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.14
|
| Rate for Payer: BCBS Transplant Transplant |
$614.40
|
| Rate for Payer: Blue Shield of California Commercial |
$632.83
|
| Rate for Payer: Blue Shield of California EPN |
$497.66
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Central Health Plan Commercial |
$819.20
|
| Rate for Payer: Cigna of CA HMO |
$655.36
|
| Rate for Payer: Cigna of CA PPO |
$757.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$870.40
|
| Rate for Payer: Global Benefits Group Commercial |
$614.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$921.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$768.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$683.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$768.00
|
| Rate for Payer: Networks By Design Commercial |
$665.60
|
| Rate for Payer: Prime Health Services Commercial |
$870.40
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$614.40
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$614.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$614.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC XR TEMP MANDIBULAR BILAT
|
Facility
IP
|
$1,024.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
909020170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$204.80 |
| Max. Negotiated Rate |
$921.60 |
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Central Health Plan Commercial |
$819.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$409.60
|
| Rate for Payer: Galaxy Health WC |
$870.40
|
| Rate for Payer: Global Benefits Group Commercial |
$614.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$921.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$683.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.80
|
| Rate for Payer: Multiplan Commercial |
$768.00
|
| Rate for Payer: Networks By Design Commercial |
$665.60
|
| Rate for Payer: Prime Health Services Commercial |
$870.40
|
|
|
HC X STNT NUMED CP
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906881017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
HC X STNT NUMED CP
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906881017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$17,854.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,854.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.54
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.50
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Riverside University Health MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
HC XYLOSE TOLERANCE BLD
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
CPT 84620
|
| Hospital Charge Code |
900910321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
|
|
HC XYLOSE TOLERANCE BLD
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 84620
|
| Hospital Charge Code |
900910321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$105.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.08
|
| Rate for Payer: BCBS Transplant Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.81
|
| Rate for Payer: Blue Shield of California EPN |
$21.87
|
| Rate for Payer: Caremore Medicare Advantage |
$12.91
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.91
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.17
|
| Rate for Payer: IEHP medi-cal |
$21.30
|
| Rate for Payer: IEHP Medicare Advantage |
$12.91
|
| Rate for Payer: Innovage PACE Commercial |
$19.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.30
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$13.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: Riverside University Health MISP |
$14.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.46
|
| Rate for Payer: United Healthcare All Other HMO |
$10.46
|
| Rate for Payer: United Healthcare HMO Rider |
$10.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.91
|
|
|
HC Y90 MICROSPHERES
|
Facility
IP
|
$25,200.00
|
|
|
Service Code
|
CPT C2616
|
| Hospital Charge Code |
909301347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,040.00 |
| Max. Negotiated Rate |
$22,680.00 |
| Rate for Payer: Blue Shield of California EPN |
$13,456.80
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,160.00
|
| Rate for Payer: Cigna of CA HMO |
$17,640.00
|
| Rate for Payer: Cigna of CA PPO |
$17,640.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,080.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,080.00
|
| Rate for Payer: Galaxy Health WC |
$21,420.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,680.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,808.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,040.00
|
| Rate for Payer: Multiplan Commercial |
$18,900.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,420.00
|
|
|
HC Y90 MICROSPHERES
|
Facility
OP
|
$25,200.00
|
|
|
Service Code
|
CPT C2616
|
| Hospital Charge Code |
909301347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,040.00 |
| Max. Negotiated Rate |
$111,844.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,524.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111,844.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33,787.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,777.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22,524.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,506.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,036.40
|
| Rate for Payer: BCBS Transplant Transplant |
$15,120.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,900.00
|
| Rate for Payer: Blue Shield of California EPN |
$13,708.80
|
| Rate for Payer: Caremore Medicare Advantage |
$22,524.90
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,160.00
|
| Rate for Payer: Cigna of CA HMO |
$17,640.00
|
| Rate for Payer: Cigna of CA PPO |
$17,640.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,787.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,408.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,524.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$22,524.90
|
| Rate for Payer: Galaxy Health WC |
$21,420.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,680.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18,900.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36,940.84
|
| Rate for Payer: IEHP medi-cal |
$37,166.08
|
| Rate for Payer: IEHP Medicare Advantage |
$22,524.90
|
| Rate for Payer: Innovage PACE Commercial |
$33,787.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,808.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,524.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,040.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,183.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,183.37
|
| Rate for Payer: Multiplan Commercial |
$18,900.00
|
| Rate for Payer: Networks By Design Commercial |
$12,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,420.00
|
| Rate for Payer: Prime Health Services Medicare |
$23,876.39
|
| Rate for Payer: Riverside University Health MISP |
$24,777.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,600.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,600.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,600.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,600.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,787.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,777.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,524.90
|
|
|
HC Y-90 ZEVALIN UP TO 40 MCI
|
Facility
IP
|
$93,735.00
|
|
|
Service Code
|
CPT A9543
|
| Hospital Charge Code |
909301343
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$18,747.00 |
| Max. Negotiated Rate |
$84,361.50 |
| Rate for Payer: Blue Shield of California Commercial |
$70,301.25
|
| Rate for Payer: Blue Shield of California EPN |
$50,054.49
|
| Rate for Payer: Cash Price |
$42,180.75
|
| Rate for Payer: Central Health Plan Commercial |
$74,988.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,494.00
|
| Rate for Payer: Galaxy Health WC |
$79,674.75
|
| Rate for Payer: Global Benefits Group Commercial |
$56,241.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$84,361.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62,521.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,747.00
|
| Rate for Payer: Multiplan Commercial |
$70,301.25
|
| Rate for Payer: Networks By Design Commercial |
$60,927.75
|
| Rate for Payer: Prime Health Services Commercial |
$79,674.75
|
|
|
HC Y-90 ZEVALIN UP TO 40 MCI
|
Facility
OP
|
$93,735.00
|
|
|
Service Code
|
CPT A9543
|
| Hospital Charge Code |
909301343
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$18,747.00 |
| Max. Negotiated Rate |
$377,488.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$65,476.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$377,488.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$98,214.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$72,024.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65,476.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109,989.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120,427.52
|
| Rate for Payer: BCBS Transplant Transplant |
$56,241.00
|
| Rate for Payer: Blue Shield of California Commercial |
$57,928.23
|
| Rate for Payer: Blue Shield of California EPN |
$45,555.21
|
| Rate for Payer: Caremore Medicare Advantage |
$65,476.58
|
| Rate for Payer: Cash Price |
$42,180.75
|
| Rate for Payer: Cash Price |
$42,180.75
|
| Rate for Payer: Central Health Plan Commercial |
$74,988.00
|
| Rate for Payer: Cigna of CA HMO |
$59,990.40
|
| Rate for Payer: Cigna of CA PPO |
$69,363.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98,214.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$88,393.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$65,476.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$65,476.58
|
| Rate for Payer: Galaxy Health WC |
$79,674.75
|
| Rate for Payer: Global Benefits Group Commercial |
$56,241.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$84,361.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$70,301.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$107,381.59
|
| Rate for Payer: IEHP medi-cal |
$108,036.36
|
| Rate for Payer: IEHP Medicare Advantage |
$65,476.58
|
| Rate for Payer: Innovage PACE Commercial |
$98,214.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62,521.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65,476.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,747.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87,738.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,738.62
|
| Rate for Payer: Multiplan Commercial |
$70,301.25
|
| Rate for Payer: Networks By Design Commercial |
$60,927.75
|
| Rate for Payer: Prime Health Services Commercial |
$79,674.75
|
| Rate for Payer: Prime Health Services Medicare |
$69,405.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$56,241.00
|
| Rate for Payer: Riverside University Health MISP |
$72,024.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56,241.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56,241.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$46,867.50
|
| Rate for Payer: United Healthcare All Other HMO |
$46,867.50
|
| Rate for Payer: United Healthcare HMO Rider |
$46,867.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46,867.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98,214.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72,024.24
|
| Rate for Payer: Vantage Medical Group Senior |
$65,476.58
|
|
|
HC YANKAUER BULB TIP ON/OFF CNTRL
|
Facility
OP
|
$7.38
|
|
| Hospital Charge Code |
901698562
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.36
|
| Rate for Payer: BCBS Transplant Transplant |
$4.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Central Health Plan Commercial |
$5.90
|
| Rate for Payer: Cigna of CA HMO |
$4.72
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.27
|
| Rate for Payer: Global Benefits Group Commercial |
$4.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.54
|
| Rate for Payer: IEHP medi-cal |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.54
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.43
|
| Rate for Payer: Riverside University Health MISP |
$2.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO |
$3.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Vantage Medical Group Senior |
$6.27
|
|
|
HC YANKAUER BULB TIP ON/OFF CNTRL
|
Facility
IP
|
$7.38
|
|
| Hospital Charge Code |
901698562
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.64 |
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Central Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.27
|
| Rate for Payer: Global Benefits Group Commercial |
$4.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.54
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.27
|
|
