|
HC PYRUVATE CSF
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$103.11 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.11
|
| Rate for Payer: Blue Shield of California Commercial |
$87.38
|
| Rate for Payer: Blue Shield of California Commercial |
$87.38
|
| Rate for Payer: Blue Shield of California EPN |
$70.09
|
| Rate for Payer: Blue Shield of California EPN |
$70.09
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.57
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$31.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.48
|
| Rate for Payer: TriValley Medical Group Senior |
$14.48
|
| Rate for Payer: TriValley Medical Group Senior |
$14.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
|
HC PYRUVATE CSF
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.84
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC QUAN MRI ANLYS BRN W/DX MRI
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
CPT 0866T
|
| Hospital Charge Code |
908801866
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$160.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$177.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$549.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$444.68
|
| Rate for Payer: Blue Shield of California Commercial |
$542.29
|
| Rate for Payer: Blue Shield of California EPN |
$433.83
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$424.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$666.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$444.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$444.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC QUAN MRI ANLYS BRN W/DX MRI
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
CPT 0866T
|
| Hospital Charge Code |
908801866
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$160.91 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Adventist Health Commercial |
$177.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$572.52
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$601.85
|
| Rate for Payer: Heritage Provider Network Senior |
$601.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.25
|
| Rate for Payer: Multiplan Commercial |
$666.75
|
|
|
HC QUAN MRI ANLYS BRN W/O DX MRI
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
CPT 0865T
|
| Hospital Charge Code |
908801865
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$160.91 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Adventist Health Commercial |
$177.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$572.52
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$601.85
|
| Rate for Payer: Heritage Provider Network Senior |
$601.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.25
|
| Rate for Payer: Multiplan Commercial |
$666.75
|
|
|
HC QUAN MRI ANLYS BRN W/O DX MRI
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
CPT 0865T
|
| Hospital Charge Code |
908801865
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$160.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$177.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$549.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$444.68
|
| Rate for Payer: Blue Shield of California Commercial |
$542.29
|
| Rate for Payer: Blue Shield of California EPN |
$433.83
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$424.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$666.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$444.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$444.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC RA223 DICLORIDE INJECTION PER MICRO CURIE
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
909301550
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$238.28
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.49
|
| Rate for Payer: Heritage Provider Network Senior |
$250.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.51
|
|
|
HC RA223 DICLORIDE INJECTION PER MICRO CURIE
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
909301550
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$199.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$275.93
|
| Rate for Payer: Blue Shield of California Commercial |
$225.70
|
| Rate for Payer: Blue Shield of California EPN |
$180.56
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$240.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$181.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$229.03
|
| Rate for Payer: Heritage Provider Network Senior |
$229.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$181.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$176.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$208.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$243.28
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$199.71
|
| Rate for Payer: TriValley Medical Group Senior |
$181.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.71
|
| Rate for Payer: Vantage Medical Group Senior |
$199.71
|
|
|
HC RADIATION TREATMENT DELIVERY INTERMEDIATE
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
909177407
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$152.94 |
| Max. Negotiated Rate |
$633.75 |
| Rate for Payer: Adventist Health Commercial |
$169.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$544.18
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$572.07
|
| Rate for Payer: Heritage Provider Network Senior |
$572.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.25
|
| Rate for Payer: Multiplan Commercial |
$633.75
|
|
|
HC RADIATION TREATMENT DELIVERY INTERMEDIATE
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
909177407
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$152.94 |
| Max. Negotiated Rate |
$744.11 |
| Rate for Payer: Adventist Health Commercial |
$169.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$522.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$744.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$545.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$496.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$549.98
|
| Rate for Payer: Blue Shield of California Commercial |
$439.49
|
| Rate for Payer: Blue Shield of California EPN |
$353.42
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$549.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$744.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$545.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$496.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$549.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$496.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$523.05
|
| Rate for Payer: Heritage Provider Network Senior |
$523.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$496.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$403.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$570.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$664.73
|
| Rate for Payer: Multiplan Commercial |
$633.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$421.66
|
| Rate for Payer: TriValley Medical Group Senior |
$421.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$422.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$422.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$744.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$545.68
|
| Rate for Payer: Vantage Medical Group Senior |
$496.07
|
|
|
HC RADIATION TREATMENT DELIVERY SIMPLE
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
909177402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$170.14 |
| Max. Negotiated Rate |
$705.00 |
| Rate for Payer: Adventist Health Commercial |
$188.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.36
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$636.38
|
| Rate for Payer: Heritage Provider Network Senior |
$636.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.00
|
| Rate for Payer: Multiplan Commercial |
$705.00
|
|
|
HC RADIATION TREATMENT DELIVERY SIMPLE
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
909177402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$111.55 |
| Max. Negotiated Rate |
$705.00 |
| Rate for Payer: Adventist Health Commercial |
$188.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$580.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.04
|
| Rate for Payer: Blue Shield of California Commercial |
$375.46
|
| Rate for Payer: Blue Shield of California EPN |
$301.93
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$611.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$611.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$131.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$581.86
|
| Rate for Payer: Heritage Provider Network Senior |
$581.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$131.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$448.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$150.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.85
|
| Rate for Payer: Multiplan Commercial |
$705.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.55
|
| Rate for Payer: TriValley Medical Group Senior |
$111.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$470.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$470.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Vantage Medical Group Senior |
$131.23
|
|
|
HC RADIATION TRT DEL COMPLEX
|
Facility
|
OP
|
$2,108.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
909100337
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$381.55 |
| Max. Negotiated Rate |
$1,581.00 |
| Rate for Payer: Adventist Health Commercial |
$421.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,302.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$569.35
|
| Rate for Payer: Blue Shield of California Commercial |
$491.47
|
| Rate for Payer: Blue Shield of California EPN |
$395.23
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,370.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$781.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$710.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,370.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$710.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,304.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,304.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$710.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,005.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$381.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$817.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$952.28
|
| Rate for Payer: Multiplan Commercial |
$1,581.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$604.06
|
| Rate for Payer: TriValley Medical Group Senior |
$604.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,054.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,054.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Vantage Medical Group Senior |
$710.66
|
|
|
HC RADIATION TRT DEL COMPLEX
|
Facility
|
IP
|
$2,108.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
909100337
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$381.55 |
| Max. Negotiated Rate |
$1,581.00 |
| Rate for Payer: Adventist Health Commercial |
$421.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,357.55
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,427.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,427.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$381.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.00
|
| Rate for Payer: Multiplan Commercial |
$1,581.00
|
|
|
HC RADIOELEMENT HANDLING/LOADING
|
Facility
|
OP
|
$1,670.00
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
909100409
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$83.53 |
| Max. Negotiated Rate |
$1,419.50 |
| Rate for Payer: Adventist Health Commercial |
$334.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,032.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,419.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$918.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,252.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.18
|
| Rate for Payer: Blue Shield of California Commercial |
$103.87
|
| Rate for Payer: Blue Shield of California EPN |
$83.53
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,085.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,419.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,419.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,419.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,085.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,033.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,033.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$796.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$302.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,169.00
|
| Rate for Payer: Multiplan Commercial |
$1,252.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$835.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$835.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,419.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,419.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,419.50
|
|
|
HC RADIOELEMENT HANDLING/LOADING
|
Facility
|
IP
|
$1,670.00
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
909100409
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$302.27 |
| Max. Negotiated Rate |
$1,252.50 |
| Rate for Payer: Adventist Health Commercial |
$334.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,075.48
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,130.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$302.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.50
|
| Rate for Payer: Multiplan Commercial |
$1,252.50
|
|
|
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 |
$634.40 |
| Max. Negotiated Rate |
$2,628.75 |
| Rate for Payer: Adventist Health Commercial |
$701.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,257.22
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,372.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,372.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$634.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.25
|
| Rate for Payer: Multiplan Commercial |
$2,628.75
|
|
|
HC RADIOPHARM THERAPY IA ADMIN
|
Facility
|
OP
|
$3,505.00
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
909020038
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$300.11 |
| Max. Negotiated Rate |
$2,628.75 |
| Rate for Payer: Adventist Health Commercial |
$701.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,166.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,753.20
|
| Rate for Payer: Blue Shield of California Commercial |
$552.34
|
| Rate for Payer: Blue Shield of California EPN |
$444.17
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,278.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,278.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$300.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,169.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2,169.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,671.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$634.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$402.15
|
| Rate for Payer: Multiplan Commercial |
$2,628.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$330.12
|
| Rate for Payer: TriValley Medical Group Senior |
$300.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,752.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,752.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
HC RADIOPHARM THERAPY INTRACAVITARY ADMIN
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
909301456
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$191.32 |
| Max. Negotiated Rate |
$792.75 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$680.71
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$715.59
|
| Rate for Payer: Heritage Provider Network Senior |
$715.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.25
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
|
|
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 |
$191.32 |
| Max. Negotiated Rate |
$792.75 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$653.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.71
|
| Rate for Payer: Blue Shield of California Commercial |
$549.46
|
| Rate for Payer: Blue Shield of California EPN |
$441.85
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$687.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$300.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$654.28
|
| Rate for Payer: Heritage Provider Network Senior |
$654.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$504.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$402.15
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$330.12
|
| Rate for Payer: TriValley Medical Group Senior |
$300.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$528.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$528.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
HC RADIOPHARM THERAPY INTRAVENOUS ADMIN
|
Facility
|
IP
|
$2,499.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301455
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$452.32 |
| Max. Negotiated Rate |
$1,874.25 |
| Rate for Payer: Adventist Health Commercial |
$499.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,609.36
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,691.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,691.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$452.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.75
|
| Rate for Payer: Multiplan Commercial |
$1,874.25
|
|
|
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 |
$300.11 |
| Max. Negotiated Rate |
$1,874.25 |
| Rate for Payer: Adventist Health Commercial |
$499.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,544.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,250.00
|
| Rate for Payer: Blue Shield of California Commercial |
$549.46
|
| Rate for Payer: Blue Shield of California EPN |
$441.85
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,624.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,624.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$300.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,546.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,546.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,192.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$452.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$402.15
|
| Rate for Payer: Multiplan Commercial |
$1,874.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$330.12
|
| Rate for Payer: TriValley Medical Group Senior |
$300.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,249.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,249.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
HC RADIOPHARM THERAPY Y-90 ZEVALIN
|
Facility
|
IP
|
$8,646.00
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
909301344
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$1,564.93 |
| Max. Negotiated Rate |
$6,484.50 |
| Rate for Payer: Adventist Health Commercial |
$1,729.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,568.02
|
| Rate for Payer: Cash Price |
$3,890.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,853.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5,853.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,564.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,161.50
|
| Rate for Payer: Multiplan Commercial |
$6,484.50
|
|
|
HC RADIOPHARM THERAPY Y-90 ZEVALIN
|
Facility
|
OP
|
$8,646.00
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
909301344
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$300.11 |
| Max. Negotiated Rate |
$6,484.50 |
| Rate for Payer: Adventist Health Commercial |
$1,729.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,343.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,324.73
|
| Rate for Payer: Blue Shield of California Commercial |
$886.80
|
| Rate for Payer: Blue Shield of California EPN |
$713.13
|
| Rate for Payer: Cash Price |
$3,890.70
|
| Rate for Payer: Cash Price |
$3,890.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,619.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,619.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$300.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,351.87
|
| Rate for Payer: Heritage Provider Network Senior |
$5,351.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,124.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,564.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,161.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$402.15
|
| Rate for Payer: Multiplan Commercial |
$6,484.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$330.12
|
| Rate for Payer: TriValley Medical Group Senior |
$300.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,323.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,323.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
HC RADIOPHRM AGNT OF TMR SNGL DAY
|
Facility
|
IP
|
$4,032.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
909301440
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$729.79 |
| Max. Negotiated Rate |
$3,024.00 |
| Rate for Payer: Adventist Health Commercial |
$806.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,596.61
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,729.66
|
| Rate for Payer: Heritage Provider Network Senior |
$2,729.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$729.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,008.00
|
| Rate for Payer: Multiplan Commercial |
$3,024.00
|
|
