|
HC HYMENOTOMY, SIMPLE INCISION
|
Facility
|
IP
|
$10,901.00
|
|
|
Service Code
|
CPT 56442
|
| Hospital Charge Code |
900506442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,180.20 |
| Max. Negotiated Rate |
$9,810.90 |
| Rate for Payer: Adventist Health Commercial |
$2,180.20
|
| Rate for Payer: Cash Price |
$5,995.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,720.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,360.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,360.40
|
| Rate for Payer: Galaxy Health WC |
$9,265.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,540.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,810.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,270.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,153.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,747.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,180.20
|
| Rate for Payer: Multiplan Commercial |
$8,175.75
|
| Rate for Payer: Networks By Design Commercial |
$7,085.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,265.85
|
|
|
HC HYMENOTOMY, SIMPLE INCISION
|
Facility
|
OP
|
$10,901.00
|
|
|
Service Code
|
CPT 56442
|
| Hospital Charge Code |
900506442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.59 |
| Max. Negotiated Rate |
$9,810.90 |
| Rate for Payer: Adventist Health Commercial |
$2,180.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Cash Price |
$5,995.55
|
| Rate for Payer: Cash Price |
$5,995.55
|
| Rate for Payer: Cash Price |
$5,995.55
|
| Rate for Payer: Cash Price |
$5,995.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,720.80
|
| Rate for Payer: Cigna of CA HMO |
$6,976.64
|
| Rate for Payer: Cigna of CA PPO |
$8,066.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$9,265.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,540.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,810.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,270.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,180.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$8,175.75
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$7,085.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$9,265.85
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,540.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,450.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,450.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,450.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,450.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
909000176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$420.30 |
| Rate for Payer: Adventist Health Commercial |
$93.40
|
| Rate for Payer: Cash Price |
$256.85
|
| Rate for Payer: Central Health Plan Commercial |
$373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$186.80
|
| Rate for Payer: Galaxy Health WC |
$396.95
|
| Rate for Payer: Global Benefits Group Commercial |
$280.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$420.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$311.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$289.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.40
|
| Rate for Payer: Multiplan Commercial |
$350.25
|
| Rate for Payer: Networks By Design Commercial |
$303.55
|
| Rate for Payer: Prime Health Services Commercial |
$396.95
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
909000176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$93.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$396.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$350.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$226.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.27
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$256.85
|
| Rate for Payer: Cash Price |
$256.85
|
| Rate for Payer: Cash Price |
$256.85
|
| Rate for Payer: Central Health Plan Commercial |
$373.60
|
| Rate for Payer: Cigna of CA HMO |
$298.88
|
| Rate for Payer: Cigna of CA PPO |
$345.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$396.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$396.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$396.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$186.80
|
| Rate for Payer: Galaxy Health WC |
$396.95
|
| Rate for Payer: Global Benefits Group Commercial |
$280.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$420.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$318.97
|
| Rate for Payer: InnovAge PACE Commercial |
$233.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$311.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$289.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$326.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$326.90
|
| Rate for Payer: Multiplan Commercial |
$350.25
|
| Rate for Payer: Networks By Design Commercial |
$303.55
|
| Rate for Payer: Prime Health Services Commercial |
$396.95
|
| Rate for Payer: Riverside University Health System MISP |
$186.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$280.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$396.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$396.95
|
| Rate for Payer: Vantage Medical Group Senior |
$396.95
|
|
|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$678.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$269.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.75
|
| Rate for Payer: Blue Shield of California Commercial |
$678.63
|
| Rate for Payer: Blue Shield of California EPN |
$443.85
|
| Rate for Payer: Cash Price |
$614.90
|
| Rate for Payer: Cash Price |
$614.90
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Cigna of CA HMO |
$715.52
|
| Rate for Payer: Cigna of CA PPO |
$827.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Cash Price |
$614.90
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.60
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
|
|
HC I-111 OXINE PER .5 MCI
|
Facility
|
OP
|
$1,468.00
|
|
|
Service Code
|
CPT A9547
|
| Hospital Charge Code |
909301529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$293.60 |
| Max. Negotiated Rate |
$1,321.20 |
| Rate for Payer: Adventist Health Commercial |
$293.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$772.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$965.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$849.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$849.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$710.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$862.16
|
| Rate for Payer: Blue Shield of California Commercial |
$896.95
|
| Rate for Payer: Blue Shield of California EPN |
$585.73
|
| Rate for Payer: Cash Price |
$807.40
|
| Rate for Payer: Cash Price |
$807.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,174.40
|
| Rate for Payer: Cigna of CA HMO |
$1,027.60
|
| Rate for Payer: Cigna of CA PPO |
$1,027.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$965.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$849.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$849.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,043.06
|
| Rate for Payer: EPIC Health Plan Senior |
$772.64
|
| Rate for Payer: Galaxy Health WC |
$1,247.80
|
| Rate for Payer: Global Benefits Group Commercial |
$880.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,321.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,267.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$401.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$772.64
|
| Rate for Payer: InnovAge PACE Commercial |
$1,158.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$979.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$772.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,035.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,035.34
|
| Rate for Payer: Multiplan Commercial |
$1,101.00
|
| Rate for Payer: Networks By Design Commercial |
$734.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$772.64
|
| Rate for Payer: Prime Health Services Commercial |
$1,247.80
|
| Rate for Payer: Prime Health Services Medicare |
$819.00
|
| Rate for Payer: Riverside University Health System MISP |
$849.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$880.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$880.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$550.94
|
| Rate for Payer: United Healthcare All Other HMO |
$536.26
|
| Rate for Payer: United Healthcare HMO Rider |
$524.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$480.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$772.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$965.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$849.90
|
| Rate for Payer: Vantage Medical Group Senior |
$849.90
|
|
|
HC I-111 OXINE PER .5 MCI
|
Facility
|
IP
|
$1,468.00
|
|
|
Service Code
|
CPT A9547
|
| Hospital Charge Code |
909301529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$293.60 |
| Max. Negotiated Rate |
$1,321.20 |
| Rate for Payer: Adventist Health Commercial |
$293.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,134.76
|
| Rate for Payer: Blue Shield of California EPN |
$739.87
|
| Rate for Payer: Cash Price |
$807.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,174.40
|
| Rate for Payer: Cigna of CA HMO |
$1,027.60
|
| Rate for Payer: Cigna of CA PPO |
$1,027.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$587.20
|
| Rate for Payer: EPIC Health Plan Senior |
$587.20
|
| Rate for Payer: Galaxy Health WC |
$1,247.80
|
| Rate for Payer: Global Benefits Group Commercial |
$880.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,321.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$979.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$559.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$908.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.60
|
| Rate for Payer: Multiplan Commercial |
$1,101.00
|
| Rate for Payer: Networks By Design Commercial |
$734.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,247.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$550.94
|
| Rate for Payer: United Healthcare All Other HMO |
$536.26
|
| Rate for Payer: United Healthcare HMO Rider |
$524.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$480.77
|
|
|
HC I-123 CAPSULES PER 100-999 UCI
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
909301511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Blue Shield of California Commercial |
$239.63
|
| Rate for Payer: Blue Shield of California EPN |
$156.24
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Central Health Plan Commercial |
$248.00
|
| Rate for Payer: Cigna of CA HMO |
$217.00
|
| Rate for Payer: Cigna of CA PPO |
$217.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$191.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: Networks By Design Commercial |
$155.00
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.34
|
| Rate for Payer: United Healthcare All Other HMO |
$113.24
|
| Rate for Payer: United Healthcare HMO Rider |
$110.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.53
|
|
|
HC I-123 CAPSULES PER 100-999 UCI
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
909301511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$170.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$150.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.06
|
| Rate for Payer: Blue Shield of California Commercial |
$189.41
|
| Rate for Payer: Blue Shield of California EPN |
$123.69
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Central Health Plan Commercial |
$248.00
|
| Rate for Payer: Cigna of CA HMO |
$217.00
|
| Rate for Payer: Cigna of CA PPO |
$217.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$263.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$263.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$153.65
|
| Rate for Payer: InnovAge PACE Commercial |
$155.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$191.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$217.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$217.00
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: Networks By Design Commercial |
$155.00
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: Riverside University Health System MISP |
$124.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.34
|
| Rate for Payer: United Healthcare All Other HMO |
$113.24
|
| Rate for Payer: United Healthcare HMO Rider |
$110.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$263.50
|
| Rate for Payer: Vantage Medical Group Senior |
$263.50
|
|
|
HC I-125 SEED
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909301514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.62
|
| Rate for Payer: Blue Shield of California Commercial |
$203.30
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: InnovAge PACE Commercial |
$131.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.10
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Networks By Design Commercial |
$131.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: Riverside University Health System MISP |
$105.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.70
|
| Rate for Payer: United Healthcare All Other HMO |
$96.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.55
|
| Rate for Payer: Vantage Medical Group Senior |
$223.55
|
|
|
HC I-125 SEED
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909301514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Blue Shield of California Commercial |
$203.30
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Networks By Design Commercial |
$131.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.70
|
| Rate for Payer: United Healthcare All Other HMO |
$96.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.13
|
|
|
HC I-125 SERUM ALBUMIN PER 5 UCI
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT A9532
|
| Hospital Charge Code |
909301517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$372.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$240.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$328.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$212.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.24
|
| Rate for Payer: Blue Shield of California Commercial |
$267.62
|
| Rate for Payer: Blue Shield of California EPN |
$174.76
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Central Health Plan Commercial |
$350.40
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$372.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$372.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$372.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$394.20
|
| Rate for Payer: InnovAge PACE Commercial |
$219.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$306.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$306.60
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: Riverside University Health System MISP |
$175.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$262.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$372.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$372.30
|
| Rate for Payer: Vantage Medical Group Senior |
$372.30
|
|
|
HC I-125 SERUM ALBUMIN PER 5 UCI
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT A9532
|
| Hospital Charge Code |
909301517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Blue Shield of California Commercial |
$338.57
|
| Rate for Payer: Blue Shield of California EPN |
$220.75
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Central Health Plan Commercial |
$350.40
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
|
|
HC I-131 IOBENGUANE/MIBG PER.5MCI
|
Facility
|
IP
|
$5,753.00
|
|
|
Service Code
|
CPT A9508
|
| Hospital Charge Code |
909301519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,150.60 |
| Max. Negotiated Rate |
$5,177.70 |
| Rate for Payer: Adventist Health Commercial |
$1,150.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,447.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,899.51
|
| Rate for Payer: Cash Price |
$3,164.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,602.40
|
| Rate for Payer: Cigna of CA HMO |
$4,027.10
|
| Rate for Payer: Cigna of CA PPO |
$4,027.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,301.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,301.20
|
| Rate for Payer: Galaxy Health WC |
$4,890.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,451.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,177.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,837.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,191.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,561.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,150.60
|
| Rate for Payer: Multiplan Commercial |
$4,314.75
|
| Rate for Payer: Networks By Design Commercial |
$2,876.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,890.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,159.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2,101.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2,056.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,884.11
|
|
|
HC I-131 IOBENGUANE/MIBG PER.5MCI
|
Facility
|
OP
|
$5,753.00
|
|
|
Service Code
|
CPT A9508
|
| Hospital Charge Code |
909301519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$792.85 |
| Max. Negotiated Rate |
$5,177.70 |
| Rate for Payer: Adventist Health Commercial |
$1,150.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,890.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,164.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,314.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,785.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,378.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3,515.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,295.45
|
| Rate for Payer: Cash Price |
$3,164.15
|
| Rate for Payer: Cash Price |
$3,164.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,602.40
|
| Rate for Payer: Cigna of CA HMO |
$4,027.10
|
| Rate for Payer: Cigna of CA PPO |
$4,027.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,890.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,890.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,890.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,301.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,301.20
|
| Rate for Payer: Galaxy Health WC |
$4,890.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,451.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,177.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.85
|
| Rate for Payer: InnovAge PACE Commercial |
$2,876.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,837.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$875.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,561.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,150.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,027.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,027.10
|
| Rate for Payer: Multiplan Commercial |
$4,314.75
|
| Rate for Payer: Networks By Design Commercial |
$2,876.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,890.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,301.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,451.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,451.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,159.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2,101.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2,056.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,884.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,890.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,890.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,890.05
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.44
|
| Rate for Payer: Blue Shield of California Commercial |
$131.72
|
| Rate for Payer: Blue Shield of California EPN |
$86.15
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.19
|
| Rate for Payer: EPIC Health Plan Senior |
$20.88
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.88
|
| Rate for Payer: InnovAge PACE Commercial |
$31.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.98
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.88
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Prime Health Services Medicare |
$22.13
|
| Rate for Payer: Riverside University Health System MISP |
$22.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.44
|
| Rate for Payer: United Healthcare All Other HMO |
$79.27
|
| Rate for Payer: United Healthcare HMO Rider |
$77.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.97
|
| Rate for Payer: Vantage Medical Group Senior |
$22.97
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Blue Shield of California Commercial |
$167.74
|
| Rate for Payer: Blue Shield of California EPN |
$109.37
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.44
|
| Rate for Payer: United Healthcare All Other HMO |
$79.27
|
| Rate for Payer: United Healthcare HMO Rider |
$77.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.07
|
|
|
HC IAP MONITORIN DEVICE
|
Facility
|
IP
|
$456.58
|
|
| Hospital Charge Code |
901698334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.32 |
| Max. Negotiated Rate |
$410.92 |
| Rate for Payer: Adventist Health Commercial |
$91.32
|
| Rate for Payer: Cash Price |
$251.12
|
| Rate for Payer: Central Health Plan Commercial |
$365.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.63
|
| Rate for Payer: EPIC Health Plan Senior |
$182.63
|
| Rate for Payer: Galaxy Health WC |
$388.09
|
| Rate for Payer: Global Benefits Group Commercial |
$273.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.32
|
| Rate for Payer: Multiplan Commercial |
$342.44
|
| Rate for Payer: Networks By Design Commercial |
$296.78
|
| Rate for Payer: Prime Health Services Commercial |
$388.09
|
|
|
HC IAP MONITORIN DEVICE
|
Facility
|
OP
|
$456.58
|
|
| Hospital Charge Code |
901698334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.32 |
| Max. Negotiated Rate |
$410.92 |
| Rate for Payer: Adventist Health Commercial |
$91.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$277.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$388.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$342.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$221.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.15
|
| Rate for Payer: Blue Shield of California Commercial |
$278.97
|
| Rate for Payer: Blue Shield of California EPN |
$182.18
|
| Rate for Payer: Cash Price |
$251.12
|
| Rate for Payer: Central Health Plan Commercial |
$365.26
|
| Rate for Payer: Cigna of CA HMO |
$292.21
|
| Rate for Payer: Cigna of CA PPO |
$337.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$388.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$388.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$388.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.63
|
| Rate for Payer: EPIC Health Plan Senior |
$182.63
|
| Rate for Payer: Galaxy Health WC |
$388.09
|
| Rate for Payer: Global Benefits Group Commercial |
$273.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.92
|
| Rate for Payer: InnovAge PACE Commercial |
$228.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$319.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$319.61
|
| Rate for Payer: Multiplan Commercial |
$342.44
|
| Rate for Payer: Networks By Design Commercial |
$296.78
|
| Rate for Payer: Prime Health Services Commercial |
$388.09
|
| Rate for Payer: Riverside University Health System MISP |
$182.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.29
|
| Rate for Payer: United Healthcare All Other HMO |
$228.29
|
| Rate for Payer: United Healthcare HMO Rider |
$228.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$388.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$388.09
|
| Rate for Payer: Vantage Medical Group Senior |
$388.09
|
|
|
HC IAP MONITORING DEVICE
|
Facility
|
OP
|
$544.62
|
|
| Hospital Charge Code |
901698404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.92 |
| Max. Negotiated Rate |
$490.16 |
| Rate for Payer: Adventist Health Commercial |
$108.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$330.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$462.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$299.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$263.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.86
|
| Rate for Payer: Blue Shield of California Commercial |
$332.76
|
| Rate for Payer: Blue Shield of California EPN |
$217.30
|
| Rate for Payer: Cash Price |
$299.54
|
| Rate for Payer: Central Health Plan Commercial |
$435.70
|
| Rate for Payer: Cigna of CA HMO |
$348.56
|
| Rate for Payer: Cigna of CA PPO |
$403.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$462.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$462.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$462.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.85
|
| Rate for Payer: EPIC Health Plan Senior |
$217.85
|
| Rate for Payer: Galaxy Health WC |
$462.93
|
| Rate for Payer: Global Benefits Group Commercial |
$326.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$490.16
|
| Rate for Payer: InnovAge PACE Commercial |
$272.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$381.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$381.23
|
| Rate for Payer: Multiplan Commercial |
$408.46
|
| Rate for Payer: Networks By Design Commercial |
$354.00
|
| Rate for Payer: Prime Health Services Commercial |
$462.93
|
| Rate for Payer: Riverside University Health System MISP |
$217.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$326.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$326.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$272.31
|
| Rate for Payer: United Healthcare All Other HMO |
$272.31
|
| Rate for Payer: United Healthcare HMO Rider |
$272.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$462.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$462.93
|
| Rate for Payer: Vantage Medical Group Senior |
$462.93
|
|
|
HC IAP MONITORING DEVICE
|
Facility
|
IP
|
$544.62
|
|
| Hospital Charge Code |
901698404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.92 |
| Max. Negotiated Rate |
$490.16 |
| Rate for Payer: Adventist Health Commercial |
$108.92
|
| Rate for Payer: Cash Price |
$299.54
|
| Rate for Payer: Central Health Plan Commercial |
$435.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.85
|
| Rate for Payer: EPIC Health Plan Senior |
$217.85
|
| Rate for Payer: Galaxy Health WC |
$462.93
|
| Rate for Payer: Global Benefits Group Commercial |
$326.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$490.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.92
|
| Rate for Payer: Multiplan Commercial |
$408.46
|
| Rate for Payer: Networks By Design Commercial |
$354.00
|
| Rate for Payer: Prime Health Services Commercial |
$462.93
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
IP
|
$8,715.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906820051
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,743.00 |
| Max. Negotiated Rate |
$7,843.50 |
| Rate for Payer: Adventist Health Commercial |
$1,743.00
|
| Rate for Payer: Cash Price |
$4,793.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,972.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,486.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,486.00
|
| Rate for Payer: Galaxy Health WC |
$7,407.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,229.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,843.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,812.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,320.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,394.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,743.00
|
| Rate for Payer: Multiplan Commercial |
$6,536.25
|
| Rate for Payer: Networks By Design Commercial |
$5,664.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,407.75
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906811333
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,004.40 |
| Max. Negotiated Rate |
$9,019.80 |
| Rate for Payer: Adventist Health Commercial |
$2,004.40
|
| Rate for Payer: Cash Price |
$5,512.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,017.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,008.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,008.80
|
| Rate for Payer: Galaxy Health WC |
$8,518.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,013.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,019.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,684.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,818.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,203.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.40
|
| Rate for Payer: Multiplan Commercial |
$7,516.50
|
| Rate for Payer: Networks By Design Commercial |
$6,514.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,518.70
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
OP
|
$10,022.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906811333
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$9,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,004.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,518.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,512.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,852.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,885.92
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,512.10
|
| Rate for Payer: Cash Price |
$5,512.10
|
| Rate for Payer: Cash Price |
$5,512.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,017.60
|
| Rate for Payer: Cigna of CA HMO |
$6,414.08
|
| Rate for Payer: Cigna of CA PPO |
$7,416.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,518.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,518.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,518.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,008.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,008.80
|
| Rate for Payer: Galaxy Health WC |
$8,518.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,013.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,019.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$934.06
|
| Rate for Payer: InnovAge PACE Commercial |
$5,011.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,684.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,031.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,203.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,015.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,015.40
|
| Rate for Payer: Multiplan Commercial |
$7,516.50
|
| Rate for Payer: Networks By Design Commercial |
$6,514.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,518.70
|
| Rate for Payer: Riverside University Health System MISP |
$4,008.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,013.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,013.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,518.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,518.70
|
| Rate for Payer: Vantage Medical Group Senior |
$8,518.70
|
|
