|
HC IMPL SPINAL CANAL CATH
|
Facility
|
OP
|
$22,359.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
900100865
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$448.89 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$4,471.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$8,137.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,137.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,964.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$12,297.45
|
| Rate for Payer: Cash Price |
$12,297.45
|
| Rate for Payer: Cash Price |
$12,297.45
|
| Rate for Payer: Central Health Plan Commercial |
$17,887.20
|
| Rate for Payer: Cigna of CA HMO |
$14,309.76
|
| Rate for Payer: Cigna of CA PPO |
$16,545.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,950.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,137.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,984.96
|
| Rate for Payer: EPIC Health Plan Senior |
$8,137.01
|
| Rate for Payer: Galaxy Health WC |
$19,005.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,415.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,123.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,344.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$448.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,137.01
|
| Rate for Payer: InnovAge PACE Commercial |
$12,205.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,913.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,137.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,471.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,903.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,903.59
|
| Rate for Payer: Multiplan Commercial |
$16,769.25
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: Networks By Design Commercial |
$14,533.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8,137.01
|
| Rate for Payer: Preferred Health Network WC |
$13,229.47
|
| Rate for Payer: Prime Health Services Commercial |
$19,005.15
|
| Rate for Payer: Prime Health Services Medicare |
$8,625.23
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Riverside University Health System MISP |
$8,950.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,415.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,137.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Vantage Medical Group Senior |
$8,137.01
|
|
|
HC IMPL SPINAL CANAL CATH
|
Facility
|
IP
|
$22,359.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
900100865
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,471.80 |
| Max. Negotiated Rate |
$20,123.10 |
| Rate for Payer: Adventist Health Commercial |
$4,471.80
|
| Rate for Payer: Cash Price |
$12,297.45
|
| Rate for Payer: Central Health Plan Commercial |
$17,887.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,943.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,943.60
|
| Rate for Payer: Galaxy Health WC |
$19,005.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,415.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,123.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,913.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,518.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,840.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,471.80
|
| Rate for Payer: Multiplan Commercial |
$16,769.25
|
| Rate for Payer: Networks By Design Commercial |
$14,533.35
|
| Rate for Payer: Prime Health Services Commercial |
$19,005.15
|
|
|
HC IMPL STJ CARDIOMEMS SENSOR
|
Facility
|
IP
|
$193,000.00
|
|
|
Service Code
|
CPT C2624
|
| Hospital Charge Code |
906813765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38,600.00 |
| Max. Negotiated Rate |
$173,700.00 |
| Rate for Payer: Adventist Health Commercial |
$38,600.00
|
| Rate for Payer: Blue Shield of California Commercial |
$149,189.00
|
| Rate for Payer: Blue Shield of California EPN |
$97,272.00
|
| Rate for Payer: Cash Price |
$106,150.00
|
| Rate for Payer: Central Health Plan Commercial |
$154,400.00
|
| Rate for Payer: Cigna of CA HMO |
$135,100.00
|
| Rate for Payer: Cigna of CA PPO |
$135,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$77,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$77,200.00
|
| Rate for Payer: Galaxy Health WC |
$164,050.00
|
| Rate for Payer: Global Benefits Group Commercial |
$115,800.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$173,700.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128,731.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73,533.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119,467.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38,600.00
|
| Rate for Payer: Multiplan Commercial |
$144,750.00
|
| Rate for Payer: Networks By Design Commercial |
$96,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$164,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$72,432.90
|
| Rate for Payer: United Healthcare All Other HMO |
$70,502.90
|
| Rate for Payer: United Healthcare HMO Rider |
$68,978.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63,207.50
|
|
|
HC IMPL STJ CARDIOMEMS SENSOR
|
Facility
|
OP
|
$193,000.00
|
|
|
Service Code
|
CPT C2624
|
| Hospital Charge Code |
906813765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38,600.00 |
| Max. Negotiated Rate |
$173,700.00 |
| Rate for Payer: Adventist Health Commercial |
$38,600.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164,050.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106,150.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88,123.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106,864.10
|
| Rate for Payer: Blue Shield of California Commercial |
$149,189.00
|
| Rate for Payer: Blue Shield of California EPN |
$97,272.00
|
| Rate for Payer: Cash Price |
$106,150.00
|
| Rate for Payer: Central Health Plan Commercial |
$154,400.00
|
| Rate for Payer: Cigna of CA HMO |
$135,100.00
|
| Rate for Payer: Cigna of CA PPO |
$135,100.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164,050.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$164,050.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$77,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$77,200.00
|
| Rate for Payer: Galaxy Health WC |
$164,050.00
|
| Rate for Payer: Global Benefits Group Commercial |
$115,800.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$173,700.00
|
| Rate for Payer: InnovAge PACE Commercial |
$96,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128,731.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119,467.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38,600.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135,100.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135,100.00
|
| Rate for Payer: Multiplan Commercial |
$144,750.00
|
| Rate for Payer: Networks By Design Commercial |
$96,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$164,050.00
|
| Rate for Payer: Riverside University Health System MISP |
$77,200.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115,800.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$72,432.90
|
| Rate for Payer: United Healthcare All Other HMO |
$70,502.90
|
| Rate for Payer: United Healthcare HMO Rider |
$68,978.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63,207.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164,050.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164,050.00
|
| Rate for Payer: Vantage Medical Group Senior |
$164,050.00
|
|
|
HC IMPL STJ DUCT II OCCL DEVICE
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.00 |
| Max. Negotiated Rate |
$9,900.00 |
| Rate for Payer: Adventist Health Commercial |
$2,200.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,503.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,544.00
|
| Rate for Payer: Cash Price |
$6,050.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,800.00
|
| Rate for Payer: Cigna of CA HMO |
$7,700.00
|
| Rate for Payer: Cigna of CA PPO |
$7,700.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.00
|
| Rate for Payer: Galaxy Health WC |
$9,350.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,337.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,191.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,809.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,200.00
|
| Rate for Payer: Multiplan Commercial |
$8,250.00
|
| Rate for Payer: Networks By Design Commercial |
$5,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,350.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,128.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4,018.30
|
| Rate for Payer: United Healthcare HMO Rider |
$3,931.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,602.50
|
|
|
HC IMPL STJ DUCT II OCCL DEVICE
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.00 |
| Max. Negotiated Rate |
$9,900.00 |
| Rate for Payer: Adventist Health Commercial |
$2,200.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,050.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,250.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,022.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,090.70
|
| Rate for Payer: Blue Shield of California Commercial |
$8,503.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,544.00
|
| Rate for Payer: Cash Price |
$6,050.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,800.00
|
| Rate for Payer: Cigna of CA HMO |
$7,700.00
|
| Rate for Payer: Cigna of CA PPO |
$7,700.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,350.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.00
|
| Rate for Payer: Galaxy Health WC |
$9,350.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,900.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,337.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,191.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,809.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,200.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,700.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,700.00
|
| Rate for Payer: Multiplan Commercial |
$8,250.00
|
| Rate for Payer: Networks By Design Commercial |
$5,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,350.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,400.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,600.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,128.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4,018.30
|
| Rate for Payer: United Healthcare HMO Rider |
$3,931.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,602.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,350.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,350.00
|
|
|
HC IMPROVE RESP FX - 15 MIN
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT G0238
|
| Hospital Charge Code |
900201803
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$109.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$31.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$332.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$300.85
|
| Rate for Payer: Cash Price |
$300.85
|
| Rate for Payer: Cash Price |
$300.85
|
| Rate for Payer: Cash Price |
$300.85
|
| Rate for Payer: Central Health Plan Commercial |
$437.60
|
| Rate for Payer: Cigna of CA HMO |
$350.08
|
| Rate for Payer: Cigna of CA PPO |
$404.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$464.95
|
| Rate for Payer: Global Benefits Group Commercial |
$328.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$492.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: InnovAge PACE Commercial |
$46.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$364.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$410.25
|
| Rate for Payer: Networks By Design Commercial |
$355.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.12
|
| Rate for Payer: Prime Health Services Commercial |
$464.95
|
| Rate for Payer: Prime Health Services Medicare |
$32.99
|
| Rate for Payer: Riverside University Health System MISP |
$34.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$328.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$328.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC IMPROVE RESP FX - 15 MIN
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT G0238
|
| Hospital Charge Code |
900201803
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$109.40 |
| Max. Negotiated Rate |
$492.30 |
| Rate for Payer: Adventist Health Commercial |
$109.40
|
| Rate for Payer: Cash Price |
$300.85
|
| Rate for Payer: Central Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.80
|
| Rate for Payer: EPIC Health Plan Senior |
$218.80
|
| Rate for Payer: Galaxy Health WC |
$464.95
|
| Rate for Payer: Global Benefits Group Commercial |
$328.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$492.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$364.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$338.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.40
|
| Rate for Payer: Multiplan Commercial |
$410.25
|
| Rate for Payer: Networks By Design Commercial |
$355.55
|
| Rate for Payer: Prime Health Services Commercial |
$464.95
|
|
|
HC IMRT TREATMENT DELIVERY COMPLEX
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
909177386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$4,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,080.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,040.00
|
| Rate for Payer: Galaxy Health WC |
$4,335.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,060.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,590.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,401.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,943.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,156.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Networks By Design Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,335.00
|
|
|
HC IMRT TREATMENT DELIVERY COMPLEX
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
909177386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$703.90 |
| Max. Negotiated Rate |
$4,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$735.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,097.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,468.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$703.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,095.70
|
| Rate for Payer: Blue Shield of California EPN |
$2,024.70
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,080.00
|
| Rate for Payer: Cigna of CA HMO |
$3,264.00
|
| Rate for Payer: Cigna of CA PPO |
$3,774.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| Rate for Payer: Galaxy Health WC |
$4,335.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,060.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,590.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,102.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,401.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$984.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Networks By Design Commercial |
$3,315.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$735.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,335.00
|
| Rate for Payer: Prime Health Services Medicare |
$779.10
|
| Rate for Payer: Riverside University Health System MISP |
$808.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,060.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$735.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC IMRT TREATMENT DELIVERY SIMPLE
|
Facility
|
IP
|
$4,249.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
909177385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$849.80 |
| Max. Negotiated Rate |
$3,824.10 |
| Rate for Payer: Adventist Health Commercial |
$849.80
|
| Rate for Payer: Cash Price |
$2,336.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,399.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,699.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,699.60
|
| Rate for Payer: Galaxy Health WC |
$3,611.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,549.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,824.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,834.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,618.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,630.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$849.80
|
| Rate for Payer: Multiplan Commercial |
$3,186.75
|
| Rate for Payer: Networks By Design Commercial |
$2,761.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,611.65
|
|
|
HC IMRT TREATMENT DELIVERY SIMPLE
|
Facility
|
OP
|
$4,249.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
909177385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$586.47 |
| Max. Negotiated Rate |
$3,824.10 |
| Rate for Payer: Adventist Health Commercial |
$849.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$735.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,580.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,889.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$586.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,579.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,686.85
|
| Rate for Payer: Cash Price |
$2,336.95
|
| Rate for Payer: Cash Price |
$2,336.95
|
| Rate for Payer: Cash Price |
$2,336.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,399.20
|
| Rate for Payer: Cigna of CA HMO |
$2,719.36
|
| Rate for Payer: Cigna of CA PPO |
$3,144.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| Rate for Payer: Galaxy Health WC |
$3,611.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,549.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,824.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,102.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,834.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$849.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$984.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| Rate for Payer: Multiplan Commercial |
$3,186.75
|
| Rate for Payer: Networks By Design Commercial |
$2,761.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$735.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,611.65
|
| Rate for Payer: Prime Health Services Medicare |
$779.10
|
| Rate for Payer: Riverside University Health System MISP |
$808.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,549.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$735.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC IN111 PENTETRTID/OCTRE/LT 6MCI
|
Facility
|
OP
|
$19,095.00
|
|
|
Service Code
|
CPT A9572
|
| Hospital Charge Code |
909301570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,914.61 |
| Max. Negotiated Rate |
$17,185.50 |
| Rate for Payer: Adventist Health Commercial |
$3,819.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,914.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,393.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,106.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,106.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,245.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,214.49
|
| Rate for Payer: Blue Shield of California Commercial |
$11,667.05
|
| Rate for Payer: Blue Shield of California EPN |
$7,618.90
|
| Rate for Payer: Cash Price |
$10,502.25
|
| Rate for Payer: Cash Price |
$10,502.25
|
| Rate for Payer: Central Health Plan Commercial |
$15,276.00
|
| Rate for Payer: Cigna of CA HMO |
$13,366.50
|
| Rate for Payer: Cigna of CA PPO |
$13,366.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,393.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,106.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,106.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,584.72
|
| Rate for Payer: EPIC Health Plan Senior |
$1,914.61
|
| Rate for Payer: Galaxy Health WC |
$16,230.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11,457.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,185.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,139.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,914.61
|
| Rate for Payer: InnovAge PACE Commercial |
$2,871.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,736.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,914.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,819.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,565.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,565.58
|
| Rate for Payer: Multiplan Commercial |
$14,321.25
|
| Rate for Payer: Networks By Design Commercial |
$9,547.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,914.61
|
| Rate for Payer: Prime Health Services Commercial |
$16,230.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,029.49
|
| Rate for Payer: Riverside University Health System MISP |
$2,106.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,457.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,457.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,166.35
|
| Rate for Payer: United Healthcare All Other HMO |
$6,975.40
|
| Rate for Payer: United Healthcare HMO Rider |
$6,824.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,253.61
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,914.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,393.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,106.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,106.07
|
|
|
HC IN111 PENTETRTID/OCTRE/LT 6MCI
|
Facility
|
IP
|
$19,095.00
|
|
|
Service Code
|
CPT A9572
|
| Hospital Charge Code |
909301570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,819.00 |
| Max. Negotiated Rate |
$17,185.50 |
| Rate for Payer: Adventist Health Commercial |
$3,819.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,760.43
|
| Rate for Payer: Blue Shield of California EPN |
$9,623.88
|
| Rate for Payer: Cash Price |
$10,502.25
|
| Rate for Payer: Central Health Plan Commercial |
$15,276.00
|
| Rate for Payer: Cigna of CA HMO |
$13,366.50
|
| Rate for Payer: Cigna of CA PPO |
$13,366.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,638.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,638.00
|
| Rate for Payer: Galaxy Health WC |
$16,230.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11,457.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,185.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,736.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,275.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,819.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,819.00
|
| Rate for Payer: Multiplan Commercial |
$14,321.25
|
| Rate for Payer: Networks By Design Commercial |
$9,547.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,230.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,166.35
|
| Rate for Payer: United Healthcare All Other HMO |
$6,975.40
|
| Rate for Payer: United Healthcare HMO Rider |
$6,824.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,253.61
|
|
|
HC IN111 PROSTASCINT UP TO 10 MCI
|
Facility
|
OP
|
$8,469.00
|
|
|
Service Code
|
CPT A9507
|
| Hospital Charge Code |
909301255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,693.80 |
| Max. Negotiated Rate |
$7,622.10 |
| Rate for Payer: Adventist Health Commercial |
$1,693.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,198.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,657.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,351.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,100.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,973.84
|
| Rate for Payer: Blue Shield of California Commercial |
$5,174.56
|
| Rate for Payer: Blue Shield of California EPN |
$3,379.13
|
| Rate for Payer: Cash Price |
$4,657.95
|
| Rate for Payer: Cash Price |
$4,657.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,775.20
|
| Rate for Payer: Cigna of CA HMO |
$5,928.30
|
| Rate for Payer: Cigna of CA PPO |
$5,928.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,198.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,198.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,198.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,387.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,387.60
|
| Rate for Payer: Galaxy Health WC |
$7,198.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,081.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,622.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,873.90
|
| Rate for Payer: InnovAge PACE Commercial |
$4,234.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,648.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,279.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,242.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,693.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,928.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,928.30
|
| Rate for Payer: Multiplan Commercial |
$6,351.75
|
| Rate for Payer: Networks By Design Commercial |
$4,234.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,198.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,387.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,081.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,081.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,178.42
|
| Rate for Payer: United Healthcare All Other HMO |
$3,093.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3,026.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,773.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,198.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,198.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7,198.65
|
|
|
HC IN111 PROSTASCINT UP TO 10 MCI
|
Facility
|
IP
|
$8,469.00
|
|
|
Service Code
|
CPT A9507
|
| Hospital Charge Code |
909301255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,693.80 |
| Max. Negotiated Rate |
$7,622.10 |
| Rate for Payer: Adventist Health Commercial |
$1,693.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,546.54
|
| Rate for Payer: Blue Shield of California EPN |
$4,268.38
|
| Rate for Payer: Cash Price |
$4,657.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,775.20
|
| Rate for Payer: Cigna of CA HMO |
$5,928.30
|
| Rate for Payer: Cigna of CA PPO |
$5,928.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,387.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,387.60
|
| Rate for Payer: Galaxy Health WC |
$7,198.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,081.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,622.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,648.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,226.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,242.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,693.80
|
| Rate for Payer: Multiplan Commercial |
$6,351.75
|
| Rate for Payer: Networks By Design Commercial |
$4,234.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,198.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,178.42
|
| Rate for Payer: United Healthcare All Other HMO |
$3,093.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3,026.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,773.60
|
|
|
HC IN111 ZEVALIN UP TO 5 MCI
|
Facility
|
IP
|
$20,828.00
|
|
|
Service Code
|
CPT A9542
|
| Hospital Charge Code |
909301342
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$4,165.60 |
| Max. Negotiated Rate |
$18,745.20 |
| Rate for Payer: Adventist Health Commercial |
$4,165.60
|
| Rate for Payer: Cash Price |
$11,455.40
|
| Rate for Payer: Central Health Plan Commercial |
$16,662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,331.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,331.20
|
| Rate for Payer: Galaxy Health WC |
$17,703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$12,496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,745.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,892.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,935.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,892.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,165.60
|
| Rate for Payer: Multiplan Commercial |
$15,621.00
|
| Rate for Payer: Networks By Design Commercial |
$13,538.20
|
| Rate for Payer: Prime Health Services Commercial |
$17,703.80
|
|
|
HC IN111 ZEVALIN UP TO 5 MCI
|
Facility
|
OP
|
$20,828.00
|
|
|
Service Code
|
CPT A9542
|
| Hospital Charge Code |
909301342
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$798.02 |
| Max. Negotiated Rate |
$18,745.20 |
| Rate for Payer: Adventist Health Commercial |
$4,165.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$798.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$997.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$877.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$877.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,084.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,232.28
|
| Rate for Payer: Blue Shield of California Commercial |
$12,642.60
|
| Rate for Payer: Blue Shield of California EPN |
$8,268.72
|
| Rate for Payer: Cash Price |
$11,455.40
|
| Rate for Payer: Cash Price |
$11,455.40
|
| Rate for Payer: Central Health Plan Commercial |
$16,662.40
|
| Rate for Payer: Cigna of CA HMO |
$13,329.92
|
| Rate for Payer: Cigna of CA PPO |
$15,412.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$997.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$877.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$877.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.33
|
| Rate for Payer: EPIC Health Plan Senior |
$798.02
|
| Rate for Payer: Galaxy Health WC |
$17,703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$12,496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,745.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,308.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,003.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$798.02
|
| Rate for Payer: InnovAge PACE Commercial |
$1,197.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,892.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,631.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$798.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,165.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,069.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,069.35
|
| Rate for Payer: Multiplan Commercial |
$15,621.00
|
| Rate for Payer: Networks By Design Commercial |
$13,538.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$798.02
|
| Rate for Payer: Prime Health Services Commercial |
$17,703.80
|
| Rate for Payer: Prime Health Services Medicare |
$845.90
|
| Rate for Payer: Riverside University Health System MISP |
$877.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,496.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,496.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,414.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,414.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,414.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,414.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$798.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$997.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$877.82
|
| Rate for Payer: Vantage Medical Group Senior |
$877.82
|
|
|
HC INACT POLIO ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890241
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC INACT POLIO ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890241
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.10
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
|
OP
|
$3,762.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$3,385.80 |
| Rate for Payer: Adventist Health Commercial |
$1,542.42
|
| 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 |
$1,845.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,230.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,209.42
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,960.77
|
| Rate for Payer: Cash Price |
$2,069.10
|
| Rate for Payer: Cash Price |
$2,069.10
|
| Rate for Payer: Cash Price |
$2,069.10
|
| Rate for Payer: Cash Price |
$2,069.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,009.60
|
| Rate for Payer: Cigna of CA HMO |
$2,407.68
|
| Rate for Payer: Cigna of CA PPO |
$2,783.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,353.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,230.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,661.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,230.63
|
| Rate for Payer: Galaxy Health WC |
$3,197.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,257.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,385.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,018.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,230.63
|
| Rate for Payer: InnovAge PACE Commercial |
$1,845.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,509.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,649.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,649.04
|
| Rate for Payer: Multiplan Commercial |
$2,821.50
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: Networks By Design Commercial |
$2,445.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,230.63
|
| Rate for Payer: Preferred Health Network WC |
$2,000.79
|
| Rate for Payer: Prime Health Services Commercial |
$3,197.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,304.47
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| Rate for Payer: Riverside University Health System MISP |
$1,353.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,257.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,257.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,230.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,230.63
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
|
IP
|
$3,762.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$752.40 |
| Max. Negotiated Rate |
$3,385.80 |
| Rate for Payer: Adventist Health Commercial |
$752.40
|
| Rate for Payer: Cash Price |
$2,069.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,009.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.80
|
| Rate for Payer: Galaxy Health WC |
$3,197.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,257.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,385.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,509.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,433.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,328.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.40
|
| Rate for Payer: Multiplan Commercial |
$2,821.50
|
| Rate for Payer: Networks By Design Commercial |
$2,445.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,197.70
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
|
IP
|
$3,762.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$752.40 |
| Max. Negotiated Rate |
$3,385.80 |
| Rate for Payer: Adventist Health Commercial |
$752.40
|
| Rate for Payer: Cash Price |
$2,069.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,009.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.80
|
| Rate for Payer: Galaxy Health WC |
$3,197.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,257.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,385.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,509.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,433.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,328.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.40
|
| Rate for Payer: Multiplan Commercial |
$2,821.50
|
| Rate for Payer: Networks By Design Commercial |
$2,445.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,197.70
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
|
OP
|
$3,762.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$3,385.80 |
| Rate for Payer: Adventist Health Commercial |
$752.40
|
| 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 |
$1,845.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,230.63
|
| 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 |
$1,960.77
|
| Rate for Payer: Cash Price |
$2,069.10
|
| Rate for Payer: Cash Price |
$2,069.10
|
| Rate for Payer: Cash Price |
$2,069.10
|
| Rate for Payer: Cash Price |
$2,069.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,009.60
|
| Rate for Payer: Cigna of CA HMO |
$2,407.68
|
| Rate for Payer: Cigna of CA PPO |
$2,783.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,353.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,230.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,661.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,230.63
|
| Rate for Payer: Galaxy Health WC |
$3,197.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,257.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,385.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,018.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,230.63
|
| Rate for Payer: InnovAge PACE Commercial |
$1,845.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,509.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,649.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,649.04
|
| Rate for Payer: Multiplan Commercial |
$2,821.50
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: Networks By Design Commercial |
$2,445.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,230.63
|
| Rate for Payer: Preferred Health Network WC |
$2,000.79
|
| Rate for Payer: Prime Health Services Commercial |
$3,197.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,304.47
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| Rate for Payer: Riverside University Health System MISP |
$1,353.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,257.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,881.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,881.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,881.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,881.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,230.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,845.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,353.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,230.63
|
|
|
HC INCISIONAL BX SKIN SINGLE LSN
|
Facility
|
IP
|
$1,538.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
900511106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$1,384.20 |
| Rate for Payer: Adventist Health Commercial |
$307.60
|
| Rate for Payer: Cash Price |
$845.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,230.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$615.20
|
| Rate for Payer: EPIC Health Plan Senior |
$615.20
|
| Rate for Payer: Galaxy Health WC |
$1,307.30
|
| Rate for Payer: Global Benefits Group Commercial |
$922.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,384.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,025.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$952.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.60
|
| Rate for Payer: Multiplan Commercial |
$1,153.50
|
| Rate for Payer: Networks By Design Commercial |
$999.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,307.30
|
|
