|
HC RA223 DICLORIDE INJECTION PER MICRO CURIE
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
909301550
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Blue Shield of California Commercial |
$556.56
|
| Rate for Payer: Blue Shield of California EPN |
$362.88
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Central Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$468.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
|
|
HC RA223 DICLORIDE INJECTION PER MICRO CURIE
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
909301550
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$437.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$602.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$422.86
|
| Rate for Payer: Blue Shield of California Commercial |
$437.04
|
| Rate for Payer: Blue Shield of California EPN |
$285.84
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Central Health Plan Commercial |
$576.00
|
| Rate for Payer: Cigna of CA HMO |
$460.80
|
| Rate for Payer: Cigna of CA PPO |
$532.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$231.90
|
| Rate for Payer: EPIC Health Plan Senior |
$171.78
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$648.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$281.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.78
|
| Rate for Payer: InnovAge PACE Commercial |
$257.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$230.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$230.19
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$468.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.78
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: Prime Health Services Medicare |
$182.09
|
| Rate for Payer: Riverside University Health System MISP |
$188.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$432.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$432.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.96
|
| Rate for Payer: Vantage Medical Group Senior |
$188.96
|
|
|
HC RADIAL ARM SUPPORT,ADJT RANCHO
|
Facility
|
IP
|
$6,338.00
|
|
|
Service Code
|
CPT L3965
|
| Hospital Charge Code |
903203965
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$1,267.60 |
| Max. Negotiated Rate |
$5,704.20 |
| Rate for Payer: Adventist Health Commercial |
$1,267.60
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,070.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,535.20
|
| Rate for Payer: Galaxy Health WC |
$5,387.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,802.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,704.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,227.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,414.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,923.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,267.60
|
| Rate for Payer: Multiplan Commercial |
$4,753.50
|
| Rate for Payer: Networks By Design Commercial |
$4,119.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,387.30
|
|
|
HC RADIAL ARM SUPPORT,ADJT RANCHO
|
Facility
|
OP
|
$6,338.00
|
|
|
Service Code
|
CPT L3965
|
| Hospital Charge Code |
903203965
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$1,267.60 |
| Max. Negotiated Rate |
$5,704.20 |
| Rate for Payer: Adventist Health Commercial |
$1,267.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,849.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,485.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,753.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,068.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,722.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3,872.52
|
| Rate for Payer: Blue Shield of California EPN |
$2,528.86
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,070.40
|
| Rate for Payer: Cigna of CA HMO |
$4,056.32
|
| Rate for Payer: Cigna of CA PPO |
$4,690.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,387.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,387.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,535.20
|
| Rate for Payer: Galaxy Health WC |
$5,387.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,802.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,704.20
|
| Rate for Payer: InnovAge PACE Commercial |
$3,169.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,227.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,414.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,923.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,267.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,436.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,436.60
|
| Rate for Payer: Multiplan Commercial |
$4,753.50
|
| Rate for Payer: Networks By Design Commercial |
$4,119.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,387.30
|
| Rate for Payer: Riverside University Health System MISP |
$2,535.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,802.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,802.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,169.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,169.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,169.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,169.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,387.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,387.30
|
|
|
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 |
$104.36
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| 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 RADIANT SKINCARE KIT-CSTM BRST
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380009
|
|
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 |
$79.29
|
| Rate for Payer: Blue Shield of California Commercial |
$104.36
|
| 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: 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: InnovAge PACE Commercial |
$67.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$79.29
|
| Rate for Payer: Blue Shield of California Commercial |
$104.36
|
| 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: 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: InnovAge PACE Commercial |
$67.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA 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 |
915380009
|
|
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 |
$104.36
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| 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 |
$334.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$957.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$501.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$334.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$421.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.52
|
| Rate for Payer: Blue Shield of California Commercial |
$956.63
|
| 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 |
$501.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$334.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.09
|
| Rate for Payer: EPIC Health Plan Senior |
$334.14
|
| 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 |
$547.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$66.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$334.14
|
| Rate for Payer: InnovAge PACE Commercial |
$501.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,051.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$447.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$447.75
|
| 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 |
$334.14
|
| Rate for Payer: Prime Health Services Commercial |
$1,339.60
|
| Rate for Payer: Prime Health Services Medicare |
$354.19
|
| Rate for Payer: Riverside University Health System MISP |
$367.55
|
| 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 |
$334.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$501.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.55
|
| Rate for Payer: Vantage Medical Group Senior |
$334.14
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,051.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$600.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$975.54
|
| 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
|
OP
|
$1,325.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
909177402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$265.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$139.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$804.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$208.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$326.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.25
|
| Rate for Payer: Blue Shield of California Commercial |
$804.27
|
| 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 |
$208.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$139.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.83
|
| Rate for Payer: EPIC Health Plan Senior |
$139.13
|
| 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 |
$228.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$139.13
|
| Rate for Payer: InnovAge PACE Commercial |
$208.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.43
|
| 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 |
$139.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,126.25
|
| Rate for Payer: Prime Health Services Medicare |
$147.48
|
| Rate for Payer: Riverside University Health System MISP |
$153.04
|
| 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 |
$139.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$208.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.04
|
| Rate for Payer: Vantage Medical Group Senior |
$139.13
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$883.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$504.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$820.17
|
| 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 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 |
$334.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,959.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$501.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$334.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$436.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,958.79
|
| 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 |
$501.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$334.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.09
|
| Rate for Payer: EPIC Health Plan Senior |
$334.14
|
| 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 |
$547.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$334.14
|
| Rate for Payer: InnovAge PACE Commercial |
$501.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,152.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$447.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$447.75
|
| 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 |
$334.14
|
| Rate for Payer: Prime Health Services Commercial |
$2,742.95
|
| Rate for Payer: Prime Health Services Medicare |
$354.19
|
| Rate for Payer: Riverside University Health System MISP |
$367.55
|
| 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 |
$334.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$501.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.55
|
| Rate for Payer: Vantage Medical Group Senior |
$334.14
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$2,152.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,229.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,997.51
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$50,404.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,791.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46,777.21
|
| 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 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 |
$935.05 |
| Max. Negotiated Rate |
$68,012.10 |
| Rate for Payer: Adventist Health Commercial |
$15,113.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,713.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45,893.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,569.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,684.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,713.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,607.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$935.05
|
| Rate for Payer: Blue Shield of California Commercial |
$45,870.38
|
| 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 |
$14,569.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,684.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,713.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,112.67
|
| Rate for Payer: EPIC Health Plan Senior |
$9,713.09
|
| 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 |
$15,929.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,386.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,713.09
|
| Rate for Payer: InnovAge PACE Commercial |
$14,569.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50,404.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,531.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,713.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,113.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,015.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,015.54
|
| 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 |
$9,713.09
|
| Rate for Payer: Prime Health Services Commercial |
$64,233.65
|
| Rate for Payer: Prime Health Services Medicare |
$10,295.88
|
| Rate for Payer: Riverside University Health System MISP |
$10,684.40
|
| 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 |
$9,713.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,569.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,684.40
|
| Rate for Payer: Vantage Medical Group Senior |
$9,713.09
|
|
|
HC RADIOELEMENT HANDLING/LOADING
|
Facility
|
OP
|
$2,736.00
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
909100409
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Adventist Health Commercial |
$547.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,661.57
|
| 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 |
$21.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,660.75
|
| 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: 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: InnovAge PACE Commercial |
$1,368.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,824.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,693.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,915.20
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$1,824.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,042.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,693.58
|
| 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 RADIOPHARM THERAPY IA ADMIN
|
Facility
|
OP
|
$3,505.00
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
909020038
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$284.78 |
| Max. Negotiated Rate |
$3,154.50 |
| Rate for Payer: Adventist Health Commercial |
$701.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$284.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,128.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$536.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,058.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2,127.53
|
| 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 |
$427.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$313.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$284.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.45
|
| Rate for Payer: EPIC Health Plan Senior |
$284.78
|
| 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 |
$467.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$344.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$284.78
|
| Rate for Payer: InnovAge PACE Commercial |
$427.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,337.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$381.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$381.61
|
| 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 |
$284.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,979.25
|
| Rate for Payer: Prime Health Services Medicare |
$301.87
|
| Rate for Payer: Riverside University Health System MISP |
$313.26
|
| 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 |
$284.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Vantage Medical Group Senior |
$284.78
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$2,337.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,335.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,169.59
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$654.28
|
| 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 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 |
$284.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$641.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$547.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$620.78
|
| Rate for Payer: Blue Shield of California Commercial |
$641.60
|
| 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 |
$427.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$313.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$284.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.45
|
| Rate for Payer: EPIC Health Plan Senior |
$284.78
|
| 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 |
$467.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$284.78
|
| Rate for Payer: InnovAge PACE Commercial |
$427.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$381.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$381.61
|
| 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 |
$284.78
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: Prime Health Services Medicare |
$301.87
|
| Rate for Payer: Riverside University Health System MISP |
$313.26
|
| 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 |
$284.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Vantage Medical Group Senior |
$284.78
|
|
|
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 |
$284.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,517.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$532.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,467.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,516.89
|
| 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 |
$427.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$313.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$284.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.45
|
| Rate for Payer: EPIC Health Plan Senior |
$284.78
|
| 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 |
$467.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$216.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$284.78
|
| Rate for Payer: InnovAge PACE Commercial |
$427.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,666.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$381.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$381.61
|
| 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 |
$284.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,124.15
|
| Rate for Payer: Prime Health Services Medicare |
$301.87
|
| Rate for Payer: Riverside University Health System MISP |
$313.26
|
| 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 |
$284.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Vantage Medical Group Senior |
$284.78
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,666.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,546.88
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$1,458.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$833.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,353.75
|
| 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
|
|
