|
HC PET METABOLIC BRAIN
|
Facility
|
IP
|
$9,195.00
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
909301636
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,206.80 |
| Max. Negotiated Rate |
$7,815.75 |
| Rate for Payer: Cash Price |
$4,137.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,678.00
|
| Rate for Payer: Galaxy Health WC |
$7,815.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,517.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,133.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,503.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,206.80
|
| Rate for Payer: Multiplan Commercial |
$7,356.00
|
| Rate for Payer: Networks By Design Commercial |
$5,976.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,815.75
|
|
|
HC PET METABOLIC BRAIN
|
Facility
|
OP
|
$9,195.00
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
909301636
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,954.68 |
| Max. Negotiated Rate |
$10,428.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,428.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,478.38
|
| Rate for Payer: Blue Distinction Transplant |
$5,517.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,434.24
|
| Rate for Payer: Blue Shield of California EPN |
$4,312.46
|
| Rate for Payer: Cash Price |
$4,137.75
|
| Rate for Payer: Cash Price |
$4,137.75
|
| Rate for Payer: Cigna of CA HMO |
$5,884.80
|
| Rate for Payer: Cigna of CA PPO |
$6,804.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$7,815.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,517.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,896.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,205.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,133.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,206.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$7,356.00
|
| Rate for Payer: Networks By Design Commercial |
$5,976.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,815.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,517.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,517.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET MYOCARDIAL PERF MULTI FLW
|
Facility
|
IP
|
$15,913.00
|
|
|
Service Code
|
CPT 78492
|
| Hospital Charge Code |
909301613
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,819.12 |
| Max. Negotiated Rate |
$13,526.05 |
| Rate for Payer: Cash Price |
$7,160.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,365.20
|
| Rate for Payer: Galaxy Health WC |
$13,526.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,547.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,613.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,062.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,819.12
|
| Rate for Payer: Multiplan Commercial |
$12,730.40
|
| Rate for Payer: Networks By Design Commercial |
$10,343.45
|
| Rate for Payer: Prime Health Services Commercial |
$13,526.05
|
|
|
HC PET MYOCARDIAL PERF MULTI FLW
|
Facility
|
OP
|
$15,913.00
|
|
|
Service Code
|
CPT 78492
|
| Hospital Charge Code |
909301613
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,954.68 |
| Max. Negotiated Rate |
$13,526.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,428.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,480.97
|
| Rate for Payer: Blue Distinction Transplant |
$9,547.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,404.58
|
| Rate for Payer: Blue Shield of California EPN |
$7,463.20
|
| Rate for Payer: Cash Price |
$7,160.85
|
| Rate for Payer: Cash Price |
$7,160.85
|
| Rate for Payer: Cigna of CA HMO |
$10,184.32
|
| Rate for Payer: Cigna of CA PPO |
$11,775.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$13,526.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,547.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,934.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,205.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,613.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,062.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,819.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$12,730.40
|
| Rate for Payer: Networks By Design Commercial |
$10,343.45
|
| Rate for Payer: Prime Health Services Commercial |
$13,526.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,547.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,547.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET MYOCARDIAL PERF SGL FLW
|
Facility
|
IP
|
$6,534.00
|
|
|
Service Code
|
CPT 78491
|
| Hospital Charge Code |
909301602
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,568.16 |
| Max. Negotiated Rate |
$5,553.90 |
| Rate for Payer: Cash Price |
$2,940.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,613.60
|
| Rate for Payer: Galaxy Health WC |
$5,553.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,920.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,358.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,489.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,568.16
|
| Rate for Payer: Multiplan Commercial |
$5,227.20
|
| Rate for Payer: Networks By Design Commercial |
$4,247.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,553.90
|
|
|
HC PET MYOCARDIAL PERF SGL FLW
|
Facility
|
OP
|
$6,534.00
|
|
|
Service Code
|
CPT 78491
|
| Hospital Charge Code |
909301602
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,568.16 |
| Max. Negotiated Rate |
$10,428.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,428.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,892.96
|
| Rate for Payer: Blue Distinction Transplant |
$3,920.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,861.59
|
| Rate for Payer: Blue Shield of California EPN |
$3,064.45
|
| Rate for Payer: Cash Price |
$2,940.30
|
| Rate for Payer: Cash Price |
$2,940.30
|
| Rate for Payer: Cigna of CA HMO |
$4,181.76
|
| Rate for Payer: Cigna of CA PPO |
$4,835.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$5,553.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,920.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,900.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,205.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,358.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,489.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,568.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$5,227.20
|
| Rate for Payer: Networks By Design Commercial |
$4,247.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,553.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,920.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,920.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET SCAN/GAMMA LYMPHOMA
|
Facility
|
IP
|
$13,736.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301467
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,296.64 |
| Max. Negotiated Rate |
$11,675.60 |
| Rate for Payer: Cash Price |
$6,181.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,494.40
|
| Rate for Payer: Galaxy Health WC |
$11,675.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,241.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,161.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,233.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,296.64
|
| Rate for Payer: Multiplan Commercial |
$10,988.80
|
| Rate for Payer: Networks By Design Commercial |
$8,928.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,675.60
|
|
|
HC PET SCAN/GAMMA LYMPHOMA
|
Facility
|
OP
|
$13,736.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301467
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,954.68 |
| Max. Negotiated Rate |
$11,675.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,428.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,183.91
|
| Rate for Payer: Blue Distinction Transplant |
$8,241.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,117.98
|
| Rate for Payer: Blue Shield of California EPN |
$6,442.18
|
| Rate for Payer: Cash Price |
$6,181.20
|
| Rate for Payer: Cash Price |
$6,181.20
|
| Rate for Payer: Cigna of CA HMO |
$8,791.04
|
| Rate for Payer: Cigna of CA PPO |
$10,164.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$11,675.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,241.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,302.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,205.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,161.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,041.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,296.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$10,988.80
|
| Rate for Payer: Networks By Design Commercial |
$8,928.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,675.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,241.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,241.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET SCAN SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$9,957.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
909301481
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,389.68 |
| Max. Negotiated Rate |
$8,463.45 |
| Rate for Payer: Cash Price |
$4,480.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,982.80
|
| Rate for Payer: Galaxy Health WC |
$8,463.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,974.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,641.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,793.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.68
|
| Rate for Payer: Multiplan Commercial |
$7,965.60
|
| Rate for Payer: Networks By Design Commercial |
$6,472.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,463.45
|
|
|
HC PET SCAN SKULL BASE TO MID THIGH
|
Facility
|
OP
|
$9,957.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
909301481
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,954.68 |
| Max. Negotiated Rate |
$10,428.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,428.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,932.38
|
| Rate for Payer: Blue Distinction Transplant |
$5,974.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,884.59
|
| Rate for Payer: Blue Shield of California EPN |
$4,669.83
|
| Rate for Payer: Cash Price |
$4,480.65
|
| Rate for Payer: Cash Price |
$4,480.65
|
| Rate for Payer: Cigna of CA HMO |
$6,372.48
|
| Rate for Payer: Cigna of CA PPO |
$7,368.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$8,463.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,974.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,467.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,205.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,641.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,851.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$7,965.60
|
| Rate for Payer: Networks By Design Commercial |
$6,472.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,463.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,974.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,974.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET SCAN WHOLE BODY
|
Facility
|
OP
|
$13,173.00
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
909301482
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,954.68 |
| Max. Negotiated Rate |
$11,197.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,428.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,848.47
|
| Rate for Payer: Blue Distinction Transplant |
$7,903.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,785.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,178.14
|
| Rate for Payer: Cash Price |
$5,927.85
|
| Rate for Payer: Cash Price |
$5,927.85
|
| Rate for Payer: Cigna of CA HMO |
$8,430.72
|
| Rate for Payer: Cigna of CA PPO |
$9,748.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$11,197.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,903.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,879.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,205.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,786.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,851.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,161.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$10,538.40
|
| Rate for Payer: Networks By Design Commercial |
$8,562.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,197.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,903.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,903.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET SCAN WHOLE BODY
|
Facility
|
IP
|
$13,173.00
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
909301482
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,161.52 |
| Max. Negotiated Rate |
$11,197.05 |
| Rate for Payer: Cash Price |
$5,927.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,269.20
|
| Rate for Payer: Galaxy Health WC |
$11,197.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,903.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,786.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,018.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,161.52
|
| Rate for Payer: Multiplan Commercial |
$10,538.40
|
| Rate for Payer: Networks By Design Commercial |
$8,562.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,197.05
|
|
|
HC PET TUMOR LIMITED
|
Facility
|
IP
|
$9,957.00
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
909301480
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,389.68 |
| Max. Negotiated Rate |
$8,463.45 |
| Rate for Payer: Cash Price |
$4,480.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,982.80
|
| Rate for Payer: Galaxy Health WC |
$8,463.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,974.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,641.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,793.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.68
|
| Rate for Payer: Multiplan Commercial |
$7,965.60
|
| Rate for Payer: Networks By Design Commercial |
$6,472.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,463.45
|
|
|
HC PET TUMOR LIMITED
|
Facility
|
OP
|
$9,957.00
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
909301480
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,774.15 |
| Max. Negotiated Rate |
$10,428.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,428.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,932.38
|
| Rate for Payer: Blue Distinction Transplant |
$5,974.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,884.59
|
| Rate for Payer: Blue Shield of California EPN |
$4,669.83
|
| Rate for Payer: Cash Price |
$4,480.65
|
| Rate for Payer: Cash Price |
$4,480.65
|
| Rate for Payer: Cigna of CA HMO |
$6,372.48
|
| Rate for Payer: Cigna of CA PPO |
$7,368.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$8,463.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,974.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,467.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,909.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,909.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,874.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,874.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,641.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,851.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$7,965.60
|
| Rate for Payer: Networks By Design Commercial |
$6,472.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,463.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,974.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,974.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
OP
|
$2,595.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906811410
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$167.10 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$672.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,205.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,427.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,427.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,546.10
|
| Rate for Payer: Blue Distinction Transplant |
$1,557.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Cigna of CA PPO |
$1,920.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,205.75
|
| Rate for Payer: Dignity Health Media |
$2,205.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,205.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,038.00
|
| Rate for Payer: Galaxy Health WC |
$2,205.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,946.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,730.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$622.80
|
| Rate for Payer: Multiplan Commercial |
$2,076.00
|
| Rate for Payer: Networks By Design Commercial |
$1,686.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,205.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,557.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,205.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,205.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,205.75
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
IP
|
$2,595.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906811410
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$622.80 |
| Max. Negotiated Rate |
$2,205.75 |
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Galaxy Health WC |
$2,205.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,730.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$988.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$622.80
|
| Rate for Payer: Multiplan Commercial |
$2,076.00
|
| Rate for Payer: Networks By Design Commercial |
$1,686.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,205.75
|
|
|
HC PHARM-CHLORIDE IV SOLUTION
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
900912107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Media |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC PHARM-GLUCOSE IV SOLUTION
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 81099
|
| Hospital Charge Code |
900912109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.13
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.45
|
| Rate for Payer: Dignity Health Media |
$14.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.80
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.45
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC PHARM-PHOSPHORUS IV SOLUTION
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
900912108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Media |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC PHARM-POTASSIUM IV SOLUTION
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
900912106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Media |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC PHARM-SODIUM IV SOLUTION
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
900912105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Media |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC PH BODY FLUID
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
900910261
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.62
|
| Rate for Payer: Blue Distinction Transplant |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.40
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.37
|
| Rate for Payer: Dignity Health Media |
$3.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.58
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.87
|
| Rate for Payer: Heritage Provider Network Transplant |
$5.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2.90
|
| Rate for Payer: United Healthcare HMO Rider |
$2.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.94
|
| Rate for Payer: Vantage Medical Group Senior |
$3.58
|
|
|
HC PHENCYCLIDINE CONF
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900910517
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.75
|
| Rate for Payer: Blue Distinction Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$145.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.20
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Media |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.27
|
| Rate for Payer: United Healthcare All Other HMO |
$30.27
|
| Rate for Payer: United Healthcare HMO Rider |
$30.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC PHENOBARBITAL (LUMINAL)
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900910409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$104.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$90.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.30
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.09
|
| Rate for Payer: Heritage Provider Network Transplant |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$24.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO |
$12.39
|
| Rate for Payer: United Healthcare HMO Rider |
$12.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC PHENYTOIN (DILANTN)
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900910400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$120.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.94
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Media |
$13.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.25
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.73
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$21.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.76
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.58
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
