|
HC RADIANT SKINCARE KIT-CSTM BRST
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.21 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.53
|
| Rate for Payer: Blue Shield of California Commercial |
$108.27
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Riverside University Health System MISP |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC RADIANT SKINCARE KIT-CSTM BRST
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$108.27
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
|
HC RADIATION TREATMENT DELIVERY INTERMEDIATE
|
Facility
|
OP
|
$1,576.00
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
909177407
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$66.68 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$315.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$496.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,624.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$744.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$545.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$496.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$421.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.85
|
| Rate for Payer: Blue Shield of California Commercial |
$992.88
|
| Rate for Payer: Blue Shield of California EPN |
$625.67
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,260.80
|
| Rate for Payer: Cigna of CA HMO |
$1,008.64
|
| Rate for Payer: Cigna of CA PPO |
$1,166.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$744.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$545.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$496.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,103.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.52
|
| Rate for Payer: EPIC Health Plan Senior |
$545.68
|
| Rate for Payer: Galaxy Health WC |
$1,339.60
|
| Rate for Payer: Global Benefits Group Commercial |
$945.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,418.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$813.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$66.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$496.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,000.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$694.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$664.73
|
| Rate for Payer: Multiplan Commercial |
$1,182.00
|
| Rate for Payer: Networks By Design Commercial |
$1,024.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$496.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,339.60
|
| Rate for Payer: Prime Health Services Medicare |
$525.83
|
| Rate for Payer: Riverside University Health System MISP |
$545.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$945.60
|
| 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 |
$496.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$744.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$545.68
|
| Rate for Payer: Vantage Medical Group Senior |
$496.07
|
|
|
HC RADIATION TREATMENT DELIVERY INTERMEDIATE
|
Facility
|
IP
|
$1,576.00
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
909177407
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$315.20 |
| Max. Negotiated Rate |
$1,418.40 |
| Rate for Payer: Adventist Health Commercial |
$315.20
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,260.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,103.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$630.40
|
| Rate for Payer: EPIC Health Plan Senior |
$630.40
|
| Rate for Payer: Galaxy Health WC |
$1,339.60
|
| Rate for Payer: Global Benefits Group Commercial |
$945.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,418.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,000.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$929.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.20
|
| Rate for Payer: Multiplan Commercial |
$1,182.00
|
| Rate for Payer: Networks By Design Commercial |
$1,024.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,339.60
|
|
|
HC RADIATION TREATMENT DELIVERY SIMPLE
|
Facility
|
IP
|
$1,325.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
909177402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$265.00 |
| Max. Negotiated Rate |
$1,192.50 |
| Rate for Payer: Adventist Health Commercial |
$265.00
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,060.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$927.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.00
|
| Rate for Payer: EPIC Health Plan Senior |
$530.00
|
| Rate for Payer: Galaxy Health WC |
$1,126.25
|
| Rate for Payer: Global Benefits Group Commercial |
$795.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,192.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$841.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$781.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.00
|
| Rate for Payer: Multiplan Commercial |
$993.75
|
| Rate for Payer: Networks By Design Commercial |
$861.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,126.25
|
|
|
HC RADIATION TREATMENT DELIVERY SIMPLE
|
Facility
|
OP
|
$1,325.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
909177402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$72.93 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$265.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$131.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,121.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$326.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.82
|
| Rate for Payer: Blue Shield of California Commercial |
$834.75
|
| Rate for Payer: Blue Shield of California EPN |
$526.02
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,060.00
|
| Rate for Payer: Cigna of CA HMO |
$848.00
|
| Rate for Payer: Cigna of CA PPO |
$980.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$927.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.53
|
| Rate for Payer: EPIC Health Plan Senior |
$144.35
|
| Rate for Payer: Galaxy Health WC |
$1,126.25
|
| Rate for Payer: Global Benefits Group Commercial |
$795.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,192.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$215.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$131.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$841.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.85
|
| Rate for Payer: Multiplan Commercial |
$993.75
|
| Rate for Payer: Networks By Design Commercial |
$861.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$131.23
|
| Rate for Payer: Prime Health Services Commercial |
$1,126.25
|
| Rate for Payer: Prime Health Services Medicare |
$139.10
|
| Rate for Payer: Riverside University Health System MISP |
$144.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$795.00
|
| 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 |
$131.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Vantage Medical Group Senior |
$131.23
|
|
|
HC RADIATION TRT DEL COMPLEX
|
Facility
|
IP
|
$3,227.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
909100337
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$645.40 |
| Max. Negotiated Rate |
$2,904.30 |
| Rate for Payer: Adventist Health Commercial |
$645.40
|
| Rate for Payer: Cash Price |
$1,452.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,581.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,258.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,290.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,290.80
|
| Rate for Payer: Galaxy Health WC |
$2,742.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,936.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,904.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,049.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,903.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.40
|
| Rate for Payer: Multiplan Commercial |
$2,420.25
|
| Rate for Payer: Networks By Design Commercial |
$2,097.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,742.95
|
|
|
HC RADIATION TRT DEL COMPLEX
|
Facility
|
OP
|
$3,227.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
909100337
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$74.30 |
| Max. Negotiated Rate |
$2,904.30 |
| Rate for Payer: Adventist Health Commercial |
$645.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$710.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,479.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$436.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$606.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,033.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,281.12
|
| Rate for Payer: Cash Price |
$1,452.15
|
| Rate for Payer: Cash Price |
$1,452.15
|
| Rate for Payer: Cash Price |
$1,452.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,581.60
|
| Rate for Payer: Cigna of CA HMO |
$2,065.28
|
| Rate for Payer: Cigna of CA PPO |
$2,387.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$781.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$710.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,258.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,172.59
|
| Rate for Payer: EPIC Health Plan Senior |
$781.73
|
| Rate for Payer: Galaxy Health WC |
$2,742.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,936.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,904.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,165.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$710.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,049.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$994.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$952.28
|
| Rate for Payer: Multiplan Commercial |
$2,420.25
|
| Rate for Payer: Networks By Design Commercial |
$2,097.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$710.66
|
| Rate for Payer: Prime Health Services Commercial |
$2,742.95
|
| Rate for Payer: Prime Health Services Medicare |
$753.30
|
| Rate for Payer: Riverside University Health System MISP |
$781.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,936.20
|
| 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 |
$710.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Vantage Medical Group Senior |
$710.66
|
|
|
HC RADIATION TRT DEL SRS LINEAR ACCELERATOR BASED
|
Facility
|
OP
|
$75,569.00
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
909177372
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,221.00 |
| Max. Negotiated Rate |
$68,012.10 |
| Rate for Payer: Adventist Health Commercial |
$15,113.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,473.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,415.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,209.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,420.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,473.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,607.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,405.16
|
| Rate for Payer: Blue Shield of California Commercial |
$47,608.47
|
| Rate for Payer: Blue Shield of California EPN |
$30,000.89
|
| Rate for Payer: Cash Price |
$34,006.05
|
| Rate for Payer: Cash Price |
$34,006.05
|
| Rate for Payer: Cash Price |
$34,006.05
|
| Rate for Payer: Central Health Plan Commercial |
$60,455.20
|
| Rate for Payer: Cigna of CA HMO |
$48,364.16
|
| Rate for Payer: Cigna of CA PPO |
$55,921.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,209.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,420.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,473.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52,898.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,630.45
|
| Rate for Payer: EPIC Health Plan Senior |
$10,420.30
|
| Rate for Payer: Galaxy Health WC |
$64,233.65
|
| Rate for Payer: Global Benefits Group Commercial |
$45,341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$68,012.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,535.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,386.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,473.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47,986.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,531.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,262.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,113.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,693.82
|
| Rate for Payer: Multiplan Commercial |
$56,676.75
|
| Rate for Payer: Networks By Design Commercial |
$49,119.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,473.00
|
| Rate for Payer: Prime Health Services Commercial |
$64,233.65
|
| Rate for Payer: Prime Health Services Medicare |
$10,041.38
|
| Rate for Payer: Riverside University Health System MISP |
$10,420.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45,341.40
|
| 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 |
$9,473.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,209.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,420.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9,473.00
|
|
|
HC RADIATION TRT DEL SRS LINEAR ACCELERATOR BASED
|
Facility
|
IP
|
$75,569.00
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
909177372
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$15,113.80 |
| Max. Negotiated Rate |
$68,012.10 |
| Rate for Payer: Adventist Health Commercial |
$15,113.80
|
| Rate for Payer: Cash Price |
$34,006.05
|
| Rate for Payer: Central Health Plan Commercial |
$60,455.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52,898.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$30,227.60
|
| Rate for Payer: Galaxy Health WC |
$64,233.65
|
| Rate for Payer: Global Benefits Group Commercial |
$45,341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$68,012.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47,986.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44,585.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,113.80
|
| Rate for Payer: Multiplan Commercial |
$56,676.75
|
| Rate for Payer: Networks By Design Commercial |
$49,119.85
|
| Rate for Payer: Prime Health Services Commercial |
$64,233.65
|
|
|
HC RADIOELEMENT HANDLING/LOADING
|
Facility
|
IP
|
$2,736.00
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
909100409
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$547.20 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Adventist Health Commercial |
$547.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,188.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,915.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,094.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,094.40
|
| Rate for Payer: Galaxy Health WC |
$2,325.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,641.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,462.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,737.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,614.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.20
|
| Rate for Payer: Multiplan Commercial |
$2,052.00
|
| Rate for Payer: Networks By Design Commercial |
$1,778.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,325.60
|
|
|
HC RADIOELEMENT HANDLING/LOADING
|
Facility
|
OP
|
$2,736.00
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
909100409
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Adventist Health Commercial |
$547.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$245.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,325.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,504.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,052.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,723.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,086.19
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,188.80
|
| Rate for Payer: Cigna of CA HMO |
$1,751.04
|
| Rate for Payer: Cigna of CA PPO |
$2,024.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,325.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,325.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,325.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,915.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,094.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,094.40
|
| Rate for Payer: Galaxy Health WC |
$2,325.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,641.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,462.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,737.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,614.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,915.20
|
| Rate for Payer: Multiplan Commercial |
$2,052.00
|
| Rate for Payer: Networks By Design Commercial |
$1,778.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,325.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,094.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,641.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,641.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,368.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,368.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,368.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,368.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,325.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,325.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,325.60
|
|
|
HC RADIOPHARM THERAPY IA ADMIN
|
Facility
|
OP
|
$3,505.00
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
909020038
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$300.11 |
| Max. Negotiated Rate |
$3,154.50 |
| Rate for Payer: Adventist Health Commercial |
$701.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$300.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$615.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$536.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,038.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2,208.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,391.48
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,804.00
|
| Rate for Payer: Cigna of CA HMO |
$2,243.20
|
| Rate for Payer: Cigna of CA PPO |
$2,593.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,453.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.18
|
| Rate for Payer: EPIC Health Plan Senior |
$330.12
|
| Rate for Payer: Galaxy Health WC |
$2,979.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,103.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,154.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$492.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$344.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,225.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$402.15
|
| Rate for Payer: Multiplan Commercial |
$2,628.75
|
| Rate for Payer: Networks By Design Commercial |
$2,278.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$300.11
|
| Rate for Payer: Prime Health Services Commercial |
$2,979.25
|
| Rate for Payer: Prime Health Services Medicare |
$318.12
|
| Rate for Payer: Riverside University Health System MISP |
$330.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,103.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,103.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$589.62
|
| Rate for Payer: United Healthcare All Other HMO |
$589.62
|
| Rate for Payer: United Healthcare HMO Rider |
$589.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$300.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
HC RADIOPHARM THERAPY IA ADMIN
|
Facility
|
IP
|
$3,505.00
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
909020038
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$701.00 |
| Max. Negotiated Rate |
$3,154.50 |
| Rate for Payer: Adventist Health Commercial |
$701.00
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,804.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,453.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,402.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,402.00
|
| Rate for Payer: Galaxy Health WC |
$2,979.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,103.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,154.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,225.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,067.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.00
|
| Rate for Payer: Multiplan Commercial |
$2,628.75
|
| Rate for Payer: Networks By Design Commercial |
$2,278.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,979.25
|
|
|
HC RADIOPHARM THERAPY INTRACAVITARY ADMIN
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
909301456
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$178.59 |
| Max. Negotiated Rate |
$951.30 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$300.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$429.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$547.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$614.86
|
| Rate for Payer: Blue Shield of California Commercial |
$665.91
|
| Rate for Payer: Blue Shield of California EPN |
$419.63
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Central Health Plan Commercial |
$845.60
|
| Rate for Payer: Cigna of CA HMO |
$676.48
|
| Rate for Payer: Cigna of CA PPO |
$782.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.18
|
| Rate for Payer: EPIC Health Plan Senior |
$330.12
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$951.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$492.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$671.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$402.15
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$300.11
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: Prime Health Services Medicare |
$318.12
|
| Rate for Payer: Riverside University Health System MISP |
$330.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$634.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$634.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$742.99
|
| Rate for Payer: United Healthcare All Other HMO |
$742.99
|
| Rate for Payer: United Healthcare HMO Rider |
$742.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$742.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$300.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
HC RADIOPHARM THERAPY INTRACAVITARY ADMIN
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
909301456
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$951.30 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Central Health Plan Commercial |
$845.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: EPIC Health Plan Senior |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$951.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$671.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
|
|
HC RADIOPHARM THERAPY INTRAVENOUS ADMIN
|
Facility
|
IP
|
$2,499.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301455
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$2,249.10 |
| Rate for Payer: Adventist Health Commercial |
$499.80
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,999.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,749.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$999.60
|
| Rate for Payer: EPIC Health Plan Senior |
$999.60
|
| Rate for Payer: Galaxy Health WC |
$2,124.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,499.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,249.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,586.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,474.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.80
|
| Rate for Payer: Multiplan Commercial |
$1,874.25
|
| Rate for Payer: Networks By Design Commercial |
$1,624.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,124.15
|
|
|
HC RADIOPHARM THERAPY INTRAVENOUS ADMIN
|
Facility
|
OP
|
$2,499.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301455
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$216.96 |
| Max. Negotiated Rate |
$2,249.10 |
| Rate for Payer: Adventist Health Commercial |
$499.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$300.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$377.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$532.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,453.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,574.37
|
| Rate for Payer: Blue Shield of California EPN |
$992.10
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,999.20
|
| Rate for Payer: Cigna of CA HMO |
$1,599.36
|
| Rate for Payer: Cigna of CA PPO |
$1,849.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,749.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.18
|
| Rate for Payer: EPIC Health Plan Senior |
$330.12
|
| Rate for Payer: Galaxy Health WC |
$2,124.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,499.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,249.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$492.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$216.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,586.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$402.15
|
| Rate for Payer: Multiplan Commercial |
$1,874.25
|
| Rate for Payer: Networks By Design Commercial |
$1,624.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$300.11
|
| Rate for Payer: Prime Health Services Commercial |
$2,124.15
|
| Rate for Payer: Prime Health Services Medicare |
$318.12
|
| Rate for Payer: Riverside University Health System MISP |
$330.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,499.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,499.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$589.62
|
| Rate for Payer: United Healthcare All Other HMO |
$589.62
|
| Rate for Payer: United Healthcare HMO Rider |
$589.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$300.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
HC RADIOPHARM THERAPY ORAL ADMIN
|
Facility
|
OP
|
$2,187.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
909301454
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$204.87 |
| Max. Negotiated Rate |
$1,968.30 |
| Rate for Payer: Adventist Health Commercial |
$437.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$300.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$347.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$532.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$740.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,377.81
|
| Rate for Payer: Blue Shield of California EPN |
$868.24
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,749.60
|
| Rate for Payer: Cigna of CA HMO |
$1,399.68
|
| Rate for Payer: Cigna of CA PPO |
$1,618.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,530.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.18
|
| Rate for Payer: EPIC Health Plan Senior |
$330.12
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,968.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$492.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,388.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$226.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$402.15
|
| Rate for Payer: Multiplan Commercial |
$1,640.25
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$300.11
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
| Rate for Payer: Prime Health Services Medicare |
$318.12
|
| Rate for Payer: Riverside University Health System MISP |
$330.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,312.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,312.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$589.62
|
| Rate for Payer: United Healthcare All Other HMO |
$589.62
|
| Rate for Payer: United Healthcare HMO Rider |
$589.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$300.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
HC RADIOPHARM THERAPY ORAL ADMIN
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
909301454
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$437.40 |
| Max. Negotiated Rate |
$1,968.30 |
| Rate for Payer: Adventist Health Commercial |
$437.40
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,749.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,530.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: EPIC Health Plan Senior |
$874.80
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,968.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,388.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,290.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.40
|
| Rate for Payer: Multiplan Commercial |
$1,640.25
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
|
|
HC RADIOPHARM THERAPY Y-90 ZEVALIN
|
Facility
|
IP
|
$8,646.00
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
909301344
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$1,729.20 |
| Max. Negotiated Rate |
$7,781.40 |
| Rate for Payer: Adventist Health Commercial |
$1,729.20
|
| Rate for Payer: Cash Price |
$3,890.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,916.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,052.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,458.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,458.40
|
| Rate for Payer: Galaxy Health WC |
$7,349.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,187.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,781.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,490.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,101.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.20
|
| Rate for Payer: Multiplan Commercial |
$6,484.50
|
| Rate for Payer: Networks By Design Commercial |
$5,619.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,349.10
|
|
|
HC RADIOPHARM THERAPY Y-90 ZEVALIN
|
Facility
|
OP
|
$8,646.00
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
909301344
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$244.69 |
| Max. Negotiated Rate |
$7,781.40 |
| Rate for Payer: Adventist Health Commercial |
$1,729.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$300.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$583.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$876.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,029.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5,446.98
|
| Rate for Payer: Blue Shield of California EPN |
$3,432.46
|
| Rate for Payer: Cash Price |
$3,890.70
|
| Rate for Payer: Cash Price |
$3,890.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,916.80
|
| Rate for Payer: Cigna of CA HMO |
$5,533.44
|
| Rate for Payer: Cigna of CA PPO |
$6,398.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,052.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.18
|
| Rate for Payer: EPIC Health Plan Senior |
$330.12
|
| Rate for Payer: Galaxy Health WC |
$7,349.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,187.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,781.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$492.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$244.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,490.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$402.15
|
| Rate for Payer: Multiplan Commercial |
$6,484.50
|
| Rate for Payer: Networks By Design Commercial |
$5,619.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$300.11
|
| Rate for Payer: Prime Health Services Commercial |
$7,349.10
|
| Rate for Payer: Prime Health Services Medicare |
$318.12
|
| Rate for Payer: Riverside University Health System MISP |
$330.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,187.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,187.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$742.99
|
| Rate for Payer: United Healthcare All Other HMO |
$742.99
|
| Rate for Payer: United Healthcare HMO Rider |
$742.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$742.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$300.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
HC RADIOPHRM AGNT OF TMR SNGL DAY
|
Facility
|
IP
|
$4,032.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
909301440
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$806.40 |
| Max. Negotiated Rate |
$3,628.80 |
| Rate for Payer: Adventist Health Commercial |
$806.40
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,225.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,822.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,612.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,612.80
|
| Rate for Payer: Galaxy Health WC |
$3,427.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,419.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,628.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,560.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.40
|
| Rate for Payer: Multiplan Commercial |
$3,024.00
|
| Rate for Payer: Networks By Design Commercial |
$2,620.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,427.20
|
|
|
HC RADIOPHRM AGNT OF TMR SNGL DAY
|
Facility
|
OP
|
$4,032.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
909301440
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$266.43 |
| Max. Negotiated Rate |
$3,628.80 |
| Rate for Payer: Adventist Health Commercial |
$806.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$698.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,808.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,140.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,345.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,540.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,600.70
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,225.60
|
| Rate for Payer: Cigna of CA HMO |
$2,580.48
|
| Rate for Payer: Cigna of CA PPO |
$2,983.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,822.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$3,427.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,419.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,628.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,560.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$3,024.00
|
| Rate for Payer: Networks By Design Commercial |
$2,620.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$698.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,427.20
|
| Rate for Payer: Prime Health Services Medicare |
$740.25
|
| Rate for Payer: Riverside University Health System MISP |
$768.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,419.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,419.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,260.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,260.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,260.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,260.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC RAGWEED WESTERN IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913638
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$159.88 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.88
|
| Rate for Payer: Blue Shield of California Commercial |
$41.58
|
| Rate for Payer: Blue Shield of California EPN |
$26.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
