|
HC PERSIMMON IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC PET/CT - TUMOR LIMITED AREA
|
Facility
|
OP
|
$11,039.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
909301483
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,853.28 |
| Max. Negotiated Rate |
$9,383.15 |
| Rate for Payer: Adventist Health Commercial |
$2,207.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,240.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,779.05
|
| Rate for Payer: Blue Shield of California Commercial |
$6,755.87
|
| Rate for Payer: Blue Shield of California EPN |
$4,459.76
|
| Rate for Payer: Cash Price |
$4,967.55
|
| Rate for Payer: Cash Price |
$4,967.55
|
| Rate for Payer: Cigna of CA HMO |
$7,064.96
|
| Rate for Payer: Cigna of CA PPO |
$8,168.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$9,383.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,623.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,573.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,363.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,041.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,649.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$8,831.20
|
| Rate for Payer: Networks By Design Commercial |
$7,175.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,383.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,623.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,623.40
|
| 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: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC PET/CT - TUMOR LIMITED AREA
|
Facility
|
IP
|
$11,039.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
909301483
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,207.80 |
| Max. Negotiated Rate |
$9,383.15 |
| Rate for Payer: Adventist Health Commercial |
$2,207.80
|
| Rate for Payer: Cash Price |
$4,967.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,415.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,415.60
|
| Rate for Payer: Galaxy Health WC |
$9,383.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,623.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,363.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,205.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,833.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,649.36
|
| Rate for Payer: Multiplan Commercial |
$8,831.20
|
| Rate for Payer: Networks By Design Commercial |
$7,175.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,383.15
|
|
|
HC PET/CT -TUMOR SKULL BASE-THIGH
|
Facility
|
IP
|
$11,878.00
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
909301484
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,375.60 |
| Max. Negotiated Rate |
$10,096.30 |
| Rate for Payer: Adventist Health Commercial |
$2,375.60
|
| Rate for Payer: Cash Price |
$5,345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,751.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,751.20
|
| Rate for Payer: Galaxy Health WC |
$10,096.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,126.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,922.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,525.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,352.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,850.72
|
| Rate for Payer: Multiplan Commercial |
$9,502.40
|
| Rate for Payer: Networks By Design Commercial |
$7,720.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,096.30
|
|
|
HC PET/CT -TUMOR SKULL BASE-THIGH
|
Facility
|
OP
|
$11,878.00
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
909301484
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,853.28 |
| Max. Negotiated Rate |
$10,096.30 |
| Rate for Payer: Adventist Health Commercial |
$2,375.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,790.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,294.28
|
| Rate for Payer: Blue Shield of California Commercial |
$7,269.34
|
| Rate for Payer: Blue Shield of California EPN |
$4,798.71
|
| Rate for Payer: Cash Price |
$5,345.10
|
| Rate for Payer: Cash Price |
$5,345.10
|
| Rate for Payer: Cigna of CA HMO |
$7,601.92
|
| Rate for Payer: Cigna of CA PPO |
$8,789.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$10,096.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,126.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,573.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,922.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,041.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,850.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$9,502.40
|
| Rate for Payer: Networks By Design Commercial |
$7,720.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,096.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,126.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,126.80
|
| 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: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC PET/CT - TUMOR WHOLE BODY
|
Facility
|
IP
|
$11,676.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301485
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,335.20 |
| Max. Negotiated Rate |
$9,924.60 |
| Rate for Payer: Adventist Health Commercial |
$2,335.20
|
| Rate for Payer: Cash Price |
$5,254.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,670.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,670.40
|
| Rate for Payer: Galaxy Health WC |
$9,924.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,005.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,787.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,448.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,227.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,802.24
|
| Rate for Payer: Multiplan Commercial |
$9,340.80
|
| Rate for Payer: Networks By Design Commercial |
$7,589.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,924.60
|
|
|
HC PET/CT - TUMOR WHOLE BODY
|
Facility
|
OP
|
$11,676.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301485
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,853.28 |
| Max. Negotiated Rate |
$9,924.60 |
| Rate for Payer: Adventist Health Commercial |
$2,335.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,658.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,170.23
|
| Rate for Payer: Blue Shield of California Commercial |
$7,145.71
|
| Rate for Payer: Blue Shield of California EPN |
$4,717.10
|
| Rate for Payer: Cash Price |
$5,254.20
|
| Rate for Payer: Cash Price |
$5,254.20
|
| Rate for Payer: Cigna of CA HMO |
$7,472.64
|
| Rate for Payer: Cigna of CA PPO |
$8,640.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$9,924.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,005.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,573.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,787.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,041.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,802.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$9,340.80
|
| Rate for Payer: Networks By Design Commercial |
$7,589.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,924.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,005.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,005.60
|
| 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: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC PET METABOLIC BRAIN
|
Facility
|
IP
|
$7,816.00
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
909301636
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,563.20 |
| Max. Negotiated Rate |
$6,643.60 |
| Rate for Payer: Adventist Health Commercial |
$1,563.20
|
| Rate for Payer: Cash Price |
$3,517.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,126.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,126.40
|
| Rate for Payer: Galaxy Health WC |
$6,643.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,689.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,213.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,977.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,838.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,875.84
|
| Rate for Payer: Multiplan Commercial |
$6,252.80
|
| Rate for Payer: Networks By Design Commercial |
$5,080.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,643.60
|
|
|
HC PET METABOLIC BRAIN
|
Facility
|
OP
|
$7,816.00
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
909301636
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,563.20 |
| Max. Negotiated Rate |
$6,643.60 |
| Rate for Payer: Adventist Health Commercial |
$1,563.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,126.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,799.81
|
| Rate for Payer: Blue Shield of California Commercial |
$4,783.39
|
| Rate for Payer: Blue Shield of California EPN |
$3,157.66
|
| Rate for Payer: Cash Price |
$3,517.20
|
| Rate for Payer: Cash Price |
$3,517.20
|
| Rate for Payer: Cigna of CA HMO |
$5,002.24
|
| Rate for Payer: Cigna of CA PPO |
$5,783.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$6,643.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,689.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,213.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,875.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$6,252.80
|
| Rate for Payer: Networks By Design Commercial |
$5,080.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,643.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,689.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,689.60
|
| 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: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC PET MYOCARDIAL PERF MULTI FLW
|
Facility
|
IP
|
$13,526.00
|
|
|
Service Code
|
CPT 78492
|
| Hospital Charge Code |
909301613
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,705.20 |
| Max. Negotiated Rate |
$11,497.10 |
| Rate for Payer: Adventist Health Commercial |
$2,705.20
|
| Rate for Payer: Cash Price |
$6,086.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,410.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,410.40
|
| Rate for Payer: Galaxy Health WC |
$11,497.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,115.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,153.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,372.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,246.24
|
| Rate for Payer: Multiplan Commercial |
$10,820.80
|
| Rate for Payer: Networks By Design Commercial |
$8,791.90
|
| Rate for Payer: Prime Health Services Commercial |
$11,497.10
|
|
|
HC PET MYOCARDIAL PERF MULTI FLW
|
Facility
|
OP
|
$13,526.00
|
|
|
Service Code
|
CPT 78492
|
| Hospital Charge Code |
909301613
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,853.28 |
| Max. Negotiated Rate |
$11,497.10 |
| Rate for Payer: Adventist Health Commercial |
$2,705.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,871.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,306.32
|
| Rate for Payer: Blue Shield of California Commercial |
$8,277.91
|
| Rate for Payer: Blue Shield of California EPN |
$5,464.50
|
| Rate for Payer: Cash Price |
$6,086.70
|
| Rate for Payer: Cash Price |
$6,086.70
|
| Rate for Payer: Cigna of CA HMO |
$8,656.64
|
| Rate for Payer: Cigna of CA PPO |
$10,009.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$11,497.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,115.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,153.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,246.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$10,820.80
|
| Rate for Payer: Networks By Design Commercial |
$8,791.90
|
| Rate for Payer: Prime Health Services Commercial |
$11,497.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,115.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,115.60
|
| 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: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC PET MYOCARDIAL PERF SGL FLW
|
Facility
|
OP
|
$5,554.00
|
|
|
Service Code
|
CPT 78491
|
| Hospital Charge Code |
909301602
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,110.80 |
| Max. Negotiated Rate |
$4,720.90 |
| Rate for Payer: Adventist Health Commercial |
$1,110.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,642.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,410.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3,399.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,243.82
|
| Rate for Payer: Cash Price |
$2,499.30
|
| Rate for Payer: Cash Price |
$2,499.30
|
| Rate for Payer: Cigna of CA HMO |
$3,554.56
|
| Rate for Payer: Cigna of CA PPO |
$4,109.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$4,720.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,332.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,704.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,116.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$4,443.20
|
| Rate for Payer: Networks By Design Commercial |
$3,610.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,720.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,332.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,332.40
|
| 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: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC PET MYOCARDIAL PERF SGL FLW
|
Facility
|
IP
|
$5,554.00
|
|
|
Service Code
|
CPT 78491
|
| Hospital Charge Code |
909301602
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,110.80 |
| Max. Negotiated Rate |
$4,720.90 |
| Rate for Payer: Adventist Health Commercial |
$1,110.80
|
| Rate for Payer: Cash Price |
$2,499.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,221.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,221.60
|
| Rate for Payer: Galaxy Health WC |
$4,720.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,332.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,704.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,116.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,437.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.96
|
| Rate for Payer: Multiplan Commercial |
$4,443.20
|
| Rate for Payer: Networks By Design Commercial |
$3,610.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,720.90
|
|
|
HC PET SCAN/GAMMA LYMPHOMA
|
Facility
|
IP
|
$11,676.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301467
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,335.20 |
| Max. Negotiated Rate |
$9,924.60 |
| Rate for Payer: Adventist Health Commercial |
$2,335.20
|
| Rate for Payer: Cash Price |
$5,254.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,670.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,670.40
|
| Rate for Payer: Galaxy Health WC |
$9,924.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,005.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,787.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,448.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,227.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,802.24
|
| Rate for Payer: Multiplan Commercial |
$9,340.80
|
| Rate for Payer: Networks By Design Commercial |
$7,589.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,924.60
|
|
|
HC PET SCAN/GAMMA LYMPHOMA
|
Facility
|
OP
|
$11,676.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301467
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,853.28 |
| Max. Negotiated Rate |
$9,924.60 |
| Rate for Payer: Adventist Health Commercial |
$2,335.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,658.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,170.23
|
| Rate for Payer: Blue Shield of California Commercial |
$7,145.71
|
| Rate for Payer: Blue Shield of California EPN |
$4,717.10
|
| Rate for Payer: Cash Price |
$5,254.20
|
| Rate for Payer: Cash Price |
$5,254.20
|
| Rate for Payer: Cigna of CA HMO |
$7,472.64
|
| Rate for Payer: Cigna of CA PPO |
$8,640.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$9,924.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,005.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,573.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,787.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,041.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,802.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$9,340.80
|
| Rate for Payer: Networks By Design Commercial |
$7,589.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,924.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,005.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,005.60
|
| 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: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC PET SCAN SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$8,463.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
909301481
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,692.60 |
| Max. Negotiated Rate |
$7,193.55 |
| Rate for Payer: Adventist Health Commercial |
$1,692.60
|
| Rate for Payer: Cash Price |
$3,808.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,385.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,385.20
|
| Rate for Payer: Galaxy Health WC |
$7,193.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,077.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,644.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,224.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,238.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,031.12
|
| Rate for Payer: Multiplan Commercial |
$6,770.40
|
| Rate for Payer: Networks By Design Commercial |
$5,500.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,193.55
|
|
|
HC PET SCAN SKULL BASE TO MID THIGH
|
Facility
|
OP
|
$8,463.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
909301481
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,692.60 |
| Max. Negotiated Rate |
$7,193.55 |
| Rate for Payer: Adventist Health Commercial |
$1,692.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,550.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,197.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5,179.36
|
| Rate for Payer: Blue Shield of California EPN |
$3,419.05
|
| Rate for Payer: Cash Price |
$3,808.35
|
| Rate for Payer: Cash Price |
$3,808.35
|
| Rate for Payer: Cigna of CA HMO |
$5,416.32
|
| Rate for Payer: Cigna of CA PPO |
$6,262.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$7,193.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,077.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,405.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,644.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,851.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,031.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$6,770.40
|
| Rate for Payer: Networks By Design Commercial |
$5,500.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,193.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,077.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,077.80
|
| 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: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC PET SCAN WHOLE BODY
|
Facility
|
OP
|
$11,197.00
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
909301482
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,853.28 |
| Max. Negotiated Rate |
$9,517.45 |
| Rate for Payer: Adventist Health Commercial |
$2,239.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,344.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,876.08
|
| Rate for Payer: Blue Shield of California Commercial |
$6,852.56
|
| Rate for Payer: Blue Shield of California EPN |
$4,523.59
|
| Rate for Payer: Cash Price |
$5,038.65
|
| Rate for Payer: Cash Price |
$5,038.65
|
| Rate for Payer: Cigna of CA HMO |
$7,166.08
|
| Rate for Payer: Cigna of CA PPO |
$8,285.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$9,517.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,718.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,405.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,468.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,851.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,687.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$8,957.60
|
| Rate for Payer: Networks By Design Commercial |
$7,278.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,517.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,718.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,718.20
|
| 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: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC PET SCAN WHOLE BODY
|
Facility
|
IP
|
$11,197.00
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
909301482
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,239.40 |
| Max. Negotiated Rate |
$9,517.45 |
| Rate for Payer: Adventist Health Commercial |
$2,239.40
|
| Rate for Payer: Cash Price |
$5,038.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,478.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,478.80
|
| Rate for Payer: Galaxy Health WC |
$9,517.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,718.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,468.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,266.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,930.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,687.28
|
| Rate for Payer: Multiplan Commercial |
$8,957.60
|
| Rate for Payer: Networks By Design Commercial |
$7,278.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,517.45
|
|
|
HC PET TUMOR LIMITED
|
Facility
|
IP
|
$8,463.00
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
909301480
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,692.60 |
| Max. Negotiated Rate |
$7,193.55 |
| Rate for Payer: Adventist Health Commercial |
$1,692.60
|
| Rate for Payer: Cash Price |
$3,808.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,385.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,385.20
|
| Rate for Payer: Galaxy Health WC |
$7,193.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,077.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,644.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,224.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,238.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,031.12
|
| Rate for Payer: Multiplan Commercial |
$6,770.40
|
| Rate for Payer: Networks By Design Commercial |
$5,500.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,193.55
|
|
|
HC PET TUMOR LIMITED
|
Facility
|
OP
|
$8,463.00
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
909301480
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,658.74 |
| Max. Negotiated Rate |
$7,193.55 |
| Rate for Payer: Adventist Health Commercial |
$1,692.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,550.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,197.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5,179.36
|
| Rate for Payer: Blue Shield of California EPN |
$3,419.05
|
| Rate for Payer: Cash Price |
$3,808.35
|
| Rate for Payer: Cash Price |
$3,808.35
|
| Rate for Payer: Cigna of CA HMO |
$5,416.32
|
| Rate for Payer: Cigna of CA PPO |
$6,262.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$7,193.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,077.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,405.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,644.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,851.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,031.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$6,770.40
|
| Rate for Payer: Networks By Design Commercial |
$5,500.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,193.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,077.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,077.80
|
| 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: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
IP
|
$2,536.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906811410
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$507.20 |
| Max. Negotiated Rate |
$2,155.60 |
| Rate for Payer: Adventist Health Commercial |
$507.20
|
| Rate for Payer: Cash Price |
$1,141.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.40
|
| Rate for Payer: Galaxy Health WC |
$2,155.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,691.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$966.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.64
|
| Rate for Payer: Multiplan Commercial |
$2,028.80
|
| Rate for Payer: Networks By Design Commercial |
$1,648.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,155.60
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
IP
|
$2,465.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906820068
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$493.00 |
| Max. Negotiated Rate |
$2,095.25 |
| Rate for Payer: Adventist Health Commercial |
$493.00
|
| Rate for Payer: Cash Price |
$1,109.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$986.00
|
| Rate for Payer: EPIC Health Plan Senior |
$986.00
|
| Rate for Payer: Galaxy Health WC |
$2,095.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,479.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,644.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$939.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,525.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$591.60
|
| Rate for Payer: Multiplan Commercial |
$1,972.00
|
| Rate for Payer: Networks By Design Commercial |
$1,602.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,095.25
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
OP
|
$2,536.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906811410
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$147.76 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$507.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,155.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,902.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,557.36
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,141.20
|
| Rate for Payer: Cash Price |
$1,141.20
|
| Rate for Payer: Cash Price |
$1,141.20
|
| Rate for Payer: Cigna of CA HMO |
$1,648.40
|
| Rate for Payer: Cigna of CA PPO |
$1,876.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,155.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,155.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,155.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.40
|
| Rate for Payer: Galaxy Health WC |
$2,155.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,691.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,775.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,775.20
|
| Rate for Payer: Multiplan Commercial |
$2,028.80
|
| Rate for Payer: Networks By Design Commercial |
$1,648.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,155.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,155.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,155.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,155.60
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
OP
|
$2,465.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906820068
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$147.76 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$493.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,095.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,355.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,848.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,513.76
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,109.25
|
| Rate for Payer: Cash Price |
$1,109.25
|
| Rate for Payer: Cash Price |
$1,109.25
|
| Rate for Payer: Cigna of CA HMO |
$1,602.25
|
| Rate for Payer: Cigna of CA PPO |
$1,824.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,095.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,095.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$986.00
|
| Rate for Payer: EPIC Health Plan Senior |
$986.00
|
| Rate for Payer: Galaxy Health WC |
$2,095.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,479.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,644.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,525.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$591.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,725.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,725.50
|
| Rate for Payer: Multiplan Commercial |
$1,972.00
|
| Rate for Payer: Networks By Design Commercial |
$1,602.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,095.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,479.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,095.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,095.25
|
|
