|
HC PYRUVATE CSF
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC QUAD BRIM ADD PREFAB
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L2520
|
| Hospital Charge Code |
905352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Blue Shield of California EPN |
$1,011.40
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,515.20
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.80
|
| Rate for Payer: Multiplan Commercial |
$1,420.50
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$715.17
|
| Rate for Payer: United Healthcare All Other HMO |
$698.51
|
| Rate for Payer: United Healthcare HMO Rider |
$683.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$625.02
|
|
|
HC QUAD BRIM ADD PREFAB
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L2520
|
| Hospital Charge Code |
905352520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$584.36 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,041.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$917.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,118.98
|
| Rate for Payer: Blue Distinction Transplant |
$1,136.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,420.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,030.34
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,515.20
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Media |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,704.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,420.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$662.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.54
|
| Rate for Payer: Multiplan Commercial |
$1,420.50
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Riverside University Health System MISP |
$757.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$947.00
|
| Rate for Payer: United Healthcare All Other HMO |
$947.00
|
| Rate for Payer: United Healthcare HMO Rider |
$947.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC QUAD BRIM ADD TO KAFO
|
Facility
|
IP
|
$1,555.00
|
|
|
Service Code
|
CPT L2510
|
| Hospital Charge Code |
905352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.00 |
| Max. Negotiated Rate |
$1,399.50 |
| Rate for Payer: Blue Shield of California EPN |
$830.37
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.00
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,399.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$592.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.00
|
| Rate for Payer: Multiplan Commercial |
$1,166.25
|
| Rate for Payer: Networks By Design Commercial |
$777.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$587.17
|
| Rate for Payer: United Healthcare All Other HMO |
$573.48
|
| Rate for Payer: United Healthcare HMO Rider |
$561.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$513.15
|
|
|
HC QUAD BRIM ADD TO KAFO
|
Facility
|
OP
|
$1,555.00
|
|
|
Service Code
|
CPT L2510
|
| Hospital Charge Code |
905352510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$544.25 |
| Max. Negotiated Rate |
$1,399.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$855.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$752.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$918.69
|
| Rate for Payer: Blue Distinction Transplant |
$933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,166.25
|
| Rate for Payer: Blue Shield of California EPN |
$845.92
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.00
|
| Rate for Payer: Cigna of CA HMO |
$1,088.50
|
| Rate for Payer: Cigna of CA PPO |
$1,088.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,321.75
|
| Rate for Payer: Dignity Health Media |
$1,321.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,321.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,399.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,166.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$544.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$637.55
|
| Rate for Payer: Multiplan Commercial |
$1,166.25
|
| Rate for Payer: Networks By Design Commercial |
$777.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: Riverside University Health System MISP |
$622.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$933.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$933.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.50
|
| Rate for Payer: United Healthcare All Other HMO |
$777.50
|
| Rate for Payer: United Healthcare HMO Rider |
$777.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$777.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,321.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,321.75
|
|
|
HC RA223 DICLORIDE INJECTION PER MICRO CURIE
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
909301550
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$125.20 |
| Max. Negotiated Rate |
$954.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$161.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$954.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$241.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$177.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$161.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$225.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.65
|
| Rate for Payer: Blue Distinction Transplant |
$375.60
|
| Rate for Payer: Blue Shield of California Commercial |
$386.87
|
| Rate for Payer: Blue Shield of California EPN |
$304.24
|
| Rate for Payer: Caremore Medicare Advantage |
$161.16
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Central Health Plan Commercial |
$500.80
|
| Rate for Payer: Cigna of CA HMO |
$400.64
|
| Rate for Payer: Cigna of CA PPO |
$463.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.74
|
| Rate for Payer: Dignity Health Media |
$161.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$177.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$161.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$161.16
|
| Rate for Payer: Galaxy Health WC |
$532.10
|
| Rate for Payer: Global Benefits Group Commercial |
$375.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$563.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$469.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$265.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$161.16
|
| Rate for Payer: InnovAge PACE Commercial |
$241.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$161.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$215.96
|
| Rate for Payer: Multiplan Commercial |
$469.50
|
| Rate for Payer: Networks By Design Commercial |
$406.90
|
| Rate for Payer: Prime Health Services Commercial |
$532.10
|
| Rate for Payer: Prime Health Services Medicare |
$170.83
|
| Rate for Payer: Riverside University Health System MISP |
$177.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$375.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$375.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$313.00
|
| Rate for Payer: United Healthcare All Other HMO |
$313.00
|
| Rate for Payer: United Healthcare HMO Rider |
$313.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$241.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$177.28
|
| Rate for Payer: Vantage Medical Group Senior |
$161.16
|
|
|
HC RA223 DICLORIDE INJECTION PER MICRO CURIE
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
909301550
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$125.20 |
| Max. Negotiated Rate |
$563.40 |
| Rate for Payer: Blue Shield of California Commercial |
$469.50
|
| Rate for Payer: Blue Shield of California EPN |
$334.28
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Central Health Plan Commercial |
$500.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.40
|
| Rate for Payer: Galaxy Health WC |
$532.10
|
| Rate for Payer: Global Benefits Group Commercial |
$375.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$563.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.20
|
| Rate for Payer: Multiplan Commercial |
$469.50
|
| Rate for Payer: Networks By Design Commercial |
$406.90
|
| Rate for Payer: Prime Health Services Commercial |
$532.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$236.38
|
| Rate for Payer: United Healthcare All Other HMO |
$230.87
|
| Rate for Payer: United Healthcare HMO Rider |
$225.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.58
|
|
|
HC RADIAL ARM SUPPORT,ADJT RANCHO
|
Facility
|
IP
|
$7,456.00
|
|
|
Service Code
|
CPT L3965
|
| Hospital Charge Code |
903203965
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$1,491.20 |
| Max. Negotiated Rate |
$6,710.40 |
| Rate for Payer: Cash Price |
$3,355.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,964.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,982.40
|
| Rate for Payer: Galaxy Health WC |
$6,337.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,473.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,710.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,840.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,491.20
|
| Rate for Payer: Multiplan Commercial |
$5,592.00
|
| Rate for Payer: Networks By Design Commercial |
$4,846.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,337.60
|
|
|
HC RADIAL ARM SUPPORT,ADJT RANCHO
|
Facility
|
OP
|
$7,456.00
|
|
|
Service Code
|
CPT L3965
|
| Hospital Charge Code |
903203965
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$1,491.20 |
| Max. Negotiated Rate |
$6,710.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,528.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,337.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,100.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,100.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,610.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,405.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,473.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,689.82
|
| Rate for Payer: Blue Shield of California EPN |
$3,645.98
|
| Rate for Payer: Cash Price |
$3,355.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,964.80
|
| Rate for Payer: Cigna of CA HMO |
$4,771.84
|
| Rate for Payer: Cigna of CA PPO |
$5,517.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,337.60
|
| Rate for Payer: Dignity Health Media |
$6,337.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,337.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,982.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,982.40
|
| Rate for Payer: Galaxy Health WC |
$6,337.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,473.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,710.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,592.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,609.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,973.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,840.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,491.20
|
| Rate for Payer: Multiplan Commercial |
$5,592.00
|
| Rate for Payer: Networks By Design Commercial |
$4,846.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,337.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,982.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,473.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,473.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,728.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,728.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,728.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,728.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,337.60
|
| Rate for Payer: Vantage Medical Group Senior |
$6,337.60
|
|
|
HC RADIATION TREATMENT DELIVERY INTERMEDIATE
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
909177407
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$238.20 |
| Max. Negotiated Rate |
$1,071.90 |
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Central Health Plan Commercial |
$952.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$476.40
|
| Rate for Payer: Galaxy Health WC |
$1,012.35
|
| Rate for Payer: Global Benefits Group Commercial |
$714.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,071.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$794.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.20
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
| Rate for Payer: Networks By Design Commercial |
$774.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,012.35
|
|
|
HC RADIATION TREATMENT DELIVERY INTERMEDIATE
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
909177407
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$73.66 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$335.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,435.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$421.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$514.00
|
| Rate for Payer: Blue Distinction Transplant |
$714.60
|
| Rate for Payer: Blue Shield of California Commercial |
$736.04
|
| Rate for Payer: Blue Shield of California EPN |
$578.83
|
| Rate for Payer: Caremore Medicare Advantage |
$335.78
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Central Health Plan Commercial |
$952.80
|
| Rate for Payer: Cigna of CA HMO |
$762.24
|
| Rate for Payer: Cigna of CA PPO |
$881.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.67
|
| Rate for Payer: Dignity Health Media |
$335.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.78
|
| Rate for Payer: Galaxy Health WC |
$1,012.35
|
| Rate for Payer: Global Benefits Group Commercial |
$714.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,071.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$893.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$550.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$554.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.78
|
| Rate for Payer: InnovAge PACE Commercial |
$503.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$794.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.95
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
| Rate for Payer: Networks By Design Commercial |
$774.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,012.35
|
| Rate for Payer: Prime Health Services Medicare |
$355.93
|
| Rate for Payer: Riverside University Health System MISP |
$369.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$714.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.36
|
| Rate for Payer: Vantage Medical Group Senior |
$335.78
|
|
|
HC RADIATION TREATMENT DELIVERY SIMPLE
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
909177402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Central Health Plan Commercial |
$801.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.80
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$901.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.40
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Networks By Design Commercial |
$651.30
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
|
|
HC RADIATION TREATMENT DELIVERY SIMPLE
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
909177402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$80.56 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$149.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$990.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$326.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$398.17
|
| Rate for Payer: Blue Distinction Transplant |
$601.20
|
| Rate for Payer: Blue Shield of California Commercial |
$619.24
|
| Rate for Payer: Blue Shield of California EPN |
$486.97
|
| Rate for Payer: Caremore Medicare Advantage |
$149.82
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Central Health Plan Commercial |
$801.60
|
| Rate for Payer: Cigna of CA HMO |
$641.28
|
| Rate for Payer: Cigna of CA PPO |
$741.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.73
|
| Rate for Payer: Dignity Health Media |
$149.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$149.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$149.82
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$901.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$751.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$245.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$247.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$149.82
|
| Rate for Payer: InnovAge PACE Commercial |
$224.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.76
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Networks By Design Commercial |
$651.30
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
| Rate for Payer: Prime Health Services Medicare |
$158.81
|
| Rate for Payer: Riverside University Health System MISP |
$164.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Vantage Medical Group Senior |
$149.82
|
|
|
HC RADIATION TRT DEL COMPLEX
|
Facility
|
IP
|
$2,440.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
909100337
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$488.00 |
| Max. Negotiated Rate |
$2,196.00 |
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,952.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$976.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$976.00
|
| Rate for Payer: Galaxy Health WC |
$2,074.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,464.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,196.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,627.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$929.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.00
|
| Rate for Payer: Multiplan Commercial |
$1,830.00
|
| Rate for Payer: Networks By Design Commercial |
$1,586.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,074.00
|
|
|
HC RADIATION TRT DEL COMPLEX
|
Facility
|
OP
|
$2,440.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
909100337
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$2,196.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$335.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,307.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$436.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.10
|
| Rate for Payer: Blue Distinction Transplant |
$1,464.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,507.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,185.84
|
| Rate for Payer: Caremore Medicare Advantage |
$335.78
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,952.00
|
| Rate for Payer: Cigna of CA HMO |
$1,561.60
|
| Rate for Payer: Cigna of CA PPO |
$1,805.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.67
|
| Rate for Payer: Dignity Health Media |
$335.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.78
|
| Rate for Payer: Galaxy Health WC |
$2,074.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,464.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,196.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,830.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$550.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$554.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.78
|
| Rate for Payer: InnovAge PACE Commercial |
$503.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,627.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.95
|
| Rate for Payer: Multiplan Commercial |
$1,830.00
|
| Rate for Payer: Networks By Design Commercial |
$1,586.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,074.00
|
| Rate for Payer: Prime Health Services Medicare |
$355.93
|
| Rate for Payer: Riverside University Health System MISP |
$369.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,464.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.36
|
| Rate for Payer: Vantage Medical Group Senior |
$335.78
|
|
|
HC RADIATION TRT DEL SRS LINEAR ACCELERATOR BASED
|
Facility
|
OP
|
$57,141.00
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
909177372
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,161.00 |
| Max. Negotiated Rate |
$51,426.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,729.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,784.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,594.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,702.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,729.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,607.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,619.68
|
| Rate for Payer: Blue Distinction Transplant |
$34,284.60
|
| Rate for Payer: Blue Shield of California Commercial |
$35,313.14
|
| Rate for Payer: Blue Shield of California EPN |
$27,770.53
|
| Rate for Payer: Caremore Medicare Advantage |
$9,729.67
|
| Rate for Payer: Cash Price |
$25,713.45
|
| Rate for Payer: Cash Price |
$25,713.45
|
| Rate for Payer: Cash Price |
$25,713.45
|
| Rate for Payer: Central Health Plan Commercial |
$45,712.80
|
| Rate for Payer: Cigna of CA HMO |
$36,570.24
|
| Rate for Payer: Cigna of CA PPO |
$42,284.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,594.50
|
| Rate for Payer: Dignity Health Media |
$9,729.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,702.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,135.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9,729.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,729.67
|
| Rate for Payer: Galaxy Health WC |
$48,569.85
|
| Rate for Payer: Global Benefits Group Commercial |
$34,284.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,426.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42,855.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,956.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,053.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,729.67
|
| Rate for Payer: InnovAge PACE Commercial |
$14,594.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38,113.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,531.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,729.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,428.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,037.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,037.76
|
| Rate for Payer: Multiplan Commercial |
$42,855.75
|
| Rate for Payer: Networks By Design Commercial |
$37,141.65
|
| Rate for Payer: Prime Health Services Commercial |
$48,569.85
|
| Rate for Payer: Prime Health Services Medicare |
$10,313.45
|
| Rate for Payer: Riverside University Health System MISP |
$10,702.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34,284.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,594.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,702.64
|
| Rate for Payer: Vantage Medical Group Senior |
$9,729.67
|
|
|
HC RADIATION TRT DEL SRS LINEAR ACCELERATOR BASED
|
Facility
|
IP
|
$57,141.00
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
909177372
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$11,428.20 |
| Max. Negotiated Rate |
$51,426.90 |
| Rate for Payer: Cash Price |
$25,713.45
|
| Rate for Payer: Central Health Plan Commercial |
$45,712.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,856.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$22,856.40
|
| Rate for Payer: Galaxy Health WC |
$48,569.85
|
| Rate for Payer: Global Benefits Group Commercial |
$34,284.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,426.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38,113.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21,770.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,428.20
|
| Rate for Payer: Multiplan Commercial |
$42,855.75
|
| Rate for Payer: Networks By Design Commercial |
$37,141.65
|
| Rate for Payer: Prime Health Services Commercial |
$48,569.85
|
|
|
HC RADIOELEMENT HANDLING/LOADING
|
Facility
|
OP
|
$2,069.00
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
909100409
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$1,862.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$216.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,758.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,137.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.01
|
| Rate for Payer: Blue Distinction Transplant |
$1,241.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,278.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,005.53
|
| Rate for Payer: Cash Price |
$931.05
|
| Rate for Payer: Cash Price |
$931.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,655.20
|
| Rate for Payer: Cigna of CA HMO |
$1,324.16
|
| Rate for Payer: Cigna of CA PPO |
$1,531.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,758.65
|
| Rate for Payer: Dignity Health Media |
$1,758.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,758.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$827.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$827.60
|
| Rate for Payer: Galaxy Health WC |
$1,758.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,241.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,862.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,551.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$724.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.80
|
| Rate for Payer: Multiplan Commercial |
$1,551.75
|
| Rate for Payer: Networks By Design Commercial |
$1,344.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,758.65
|
| Rate for Payer: Riverside University Health System MISP |
$827.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,241.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,241.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,034.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,034.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,034.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,034.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,758.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,758.65
|
|
|
HC RADIOELEMENT HANDLING/LOADING
|
Facility
|
IP
|
$2,069.00
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
909100409
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$413.80 |
| Max. Negotiated Rate |
$1,862.10 |
| Rate for Payer: Cash Price |
$931.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,655.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$827.60
|
| Rate for Payer: Galaxy Health WC |
$1,758.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,241.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,862.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.80
|
| Rate for Payer: Multiplan Commercial |
$1,551.75
|
| Rate for Payer: Networks By Design Commercial |
$1,344.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,758.65
|
|
|
HC RADIOPHARM THERAPY IA ADMIN
|
Facility
|
OP
|
$5,609.00
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
909020038
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$310.84 |
| Max. Negotiated Rate |
$5,048.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$310.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$541.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$536.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,313.80
|
| Rate for Payer: Blue Distinction Transplant |
$3,365.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,466.36
|
| Rate for Payer: Blue Shield of California EPN |
$2,725.97
|
| Rate for Payer: Caremore Medicare Advantage |
$310.84
|
| Rate for Payer: Cash Price |
$2,524.05
|
| Rate for Payer: Cash Price |
$2,524.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,487.20
|
| Rate for Payer: Cigna of CA HMO |
$3,589.76
|
| Rate for Payer: Cigna of CA PPO |
$4,150.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.26
|
| Rate for Payer: Dignity Health Media |
$310.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$310.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.84
|
| Rate for Payer: Galaxy Health WC |
$4,767.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,365.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,048.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,206.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$509.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$512.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$310.84
|
| Rate for Payer: InnovAge PACE Commercial |
$466.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,741.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$416.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$416.53
|
| Rate for Payer: Multiplan Commercial |
$4,206.75
|
| Rate for Payer: Networks By Design Commercial |
$3,645.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,767.65
|
| Rate for Payer: Prime Health Services Medicare |
$329.49
|
| Rate for Payer: Riverside University Health System MISP |
$341.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,365.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,365.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Vantage Medical Group Senior |
$310.84
|
|
|
HC RADIOPHARM THERAPY IA ADMIN
|
Facility
|
IP
|
$5,609.00
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
909020038
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,121.80 |
| Max. Negotiated Rate |
$5,048.10 |
| Rate for Payer: Cash Price |
$2,524.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,487.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,243.60
|
| Rate for Payer: Galaxy Health WC |
$4,767.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,365.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,048.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,741.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,137.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.80
|
| Rate for Payer: Multiplan Commercial |
$4,206.75
|
| Rate for Payer: Networks By Design Commercial |
$3,645.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,767.65
|
|
|
HC RADIOPHARM THERAPY INTRACAVITARY ADMIN
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
909301456
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$197.28 |
| Max. Negotiated Rate |
$1,178.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$310.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$379.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$547.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$773.36
|
| Rate for Payer: Blue Distinction Transplant |
$785.40
|
| Rate for Payer: Blue Shield of California Commercial |
$808.96
|
| Rate for Payer: Blue Shield of California EPN |
$636.17
|
| Rate for Payer: Caremore Medicare Advantage |
$310.84
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,047.20
|
| Rate for Payer: Cigna of CA HMO |
$837.76
|
| Rate for Payer: Cigna of CA PPO |
$968.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.26
|
| Rate for Payer: Dignity Health Media |
$310.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$310.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.84
|
| Rate for Payer: Galaxy Health WC |
$1,112.65
|
| Rate for Payer: Global Benefits Group Commercial |
$785.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,178.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$981.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$509.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$512.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$310.84
|
| Rate for Payer: InnovAge PACE Commercial |
$466.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$416.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$416.53
|
| Rate for Payer: Multiplan Commercial |
$981.75
|
| Rate for Payer: Networks By Design Commercial |
$850.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,112.65
|
| Rate for Payer: Prime Health Services Medicare |
$329.49
|
| Rate for Payer: Riverside University Health System MISP |
$341.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$785.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$785.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Vantage Medical Group Senior |
$310.84
|
|
|
HC RADIOPHARM THERAPY INTRACAVITARY ADMIN
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
909301456
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$261.80 |
| Max. Negotiated Rate |
$1,178.10 |
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,047.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.60
|
| Rate for Payer: Galaxy Health WC |
$1,112.65
|
| Rate for Payer: Global Benefits Group Commercial |
$785.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,178.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$498.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.80
|
| Rate for Payer: Multiplan Commercial |
$981.75
|
| Rate for Payer: Networks By Design Commercial |
$850.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,112.65
|
|
|
HC RADIOPHARM THERAPY INTRAVENOUS ADMIN
|
Facility
|
IP
|
$3,095.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301455
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$619.00 |
| Max. Negotiated Rate |
$2,785.50 |
| Rate for Payer: Cash Price |
$1,392.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,238.00
|
| Rate for Payer: Galaxy Health WC |
$2,630.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,857.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,785.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,064.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,179.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$619.00
|
| Rate for Payer: Multiplan Commercial |
$2,321.25
|
| Rate for Payer: Networks By Design Commercial |
$2,011.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,630.75
|
|
|
HC RADIOPHARM THERAPY INTRAVENOUS ADMIN
|
Facility
|
OP
|
$3,095.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301455
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$239.67 |
| Max. Negotiated Rate |
$2,785.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$310.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$532.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,828.53
|
| Rate for Payer: Blue Distinction Transplant |
$1,857.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,912.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,504.17
|
| Rate for Payer: Caremore Medicare Advantage |
$310.84
|
| Rate for Payer: Cash Price |
$1,392.75
|
| Rate for Payer: Cash Price |
$1,392.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,476.00
|
| Rate for Payer: Cigna of CA HMO |
$1,980.80
|
| Rate for Payer: Cigna of CA PPO |
$2,290.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.26
|
| Rate for Payer: Dignity Health Media |
$310.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$310.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.84
|
| Rate for Payer: Galaxy Health WC |
$2,630.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,857.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,785.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,321.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$509.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$512.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$310.84
|
| Rate for Payer: InnovAge PACE Commercial |
$466.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,064.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$619.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$416.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$416.53
|
| Rate for Payer: Multiplan Commercial |
$2,321.25
|
| Rate for Payer: Networks By Design Commercial |
$2,011.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,630.75
|
| Rate for Payer: Prime Health Services Medicare |
$329.49
|
| Rate for Payer: Riverside University Health System MISP |
$341.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,857.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,857.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Vantage Medical Group Senior |
$310.84
|
|
