|
HC PERQ STEN/CHEST VERT ART
|
Facility
|
OP
|
$33,569.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,374.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$6,713.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28,533.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,462.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,176.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,411.00
|
| 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 |
$18,462.95
|
| Rate for Payer: Cash Price |
$18,462.95
|
| Rate for Payer: Cigna of CA HMO |
$21,484.16
|
| Rate for Payer: Cigna of CA PPO |
$24,841.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28,533.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$28,533.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,533.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13,427.60
|
| Rate for Payer: Galaxy Health WC |
$28,533.65
|
| Rate for Payer: Global Benefits Group Commercial |
$20,141.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,390.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,789.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,779.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,056.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,498.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,498.30
|
| Rate for Payer: Multiplan Commercial |
$26,855.20
|
| Rate for Payer: Networks By Design Commercial |
$21,819.85
|
| Rate for Payer: Prime Health Services Commercial |
$28,533.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,141.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28,533.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28,533.65
|
| Rate for Payer: Vantage Medical Group Senior |
$28,533.65
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
OP
|
$47,234.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$949.65 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$9,446.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,192.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| 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 |
$25,978.70
|
| Rate for Payer: Cash Price |
$25,978.70
|
| Rate for Payer: Cash Price |
$25,978.70
|
| Rate for Payer: Cigna of CA HMO |
$30,702.10
|
| Rate for Payer: Cigna of CA PPO |
$34,953.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$40,148.90
|
| Rate for Payer: Global Benefits Group Commercial |
$28,340.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$949.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,505.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,074.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,336.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$37,787.20
|
| Rate for Payer: Networks By Design Commercial |
$30,702.10
|
| Rate for Payer: Prime Health Services Commercial |
$40,148.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,340.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,340.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
IP
|
$47,234.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,446.80 |
| Max. Negotiated Rate |
$40,148.90 |
| Rate for Payer: Adventist Health Commercial |
$9,446.80
|
| Rate for Payer: Cash Price |
$25,978.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,893.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,893.60
|
| Rate for Payer: Galaxy Health WC |
$40,148.90
|
| Rate for Payer: Global Benefits Group Commercial |
$28,340.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,505.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,996.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,237.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,336.16
|
| Rate for Payer: Multiplan Commercial |
$37,787.20
|
| Rate for Payer: Networks By Design Commercial |
$30,702.10
|
| Rate for Payer: Prime Health Services Commercial |
$40,148.90
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
IP
|
$47,231.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
906820092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,446.20 |
| Max. Negotiated Rate |
$40,146.35 |
| Rate for Payer: Adventist Health Commercial |
$9,446.20
|
| Rate for Payer: Cash Price |
$25,977.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18,892.40
|
| Rate for Payer: Galaxy Health WC |
$40,146.35
|
| Rate for Payer: Global Benefits Group Commercial |
$28,338.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,503.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,995.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,235.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,335.44
|
| Rate for Payer: Multiplan Commercial |
$37,784.80
|
| Rate for Payer: Networks By Design Commercial |
$30,700.15
|
| Rate for Payer: Prime Health Services Commercial |
$40,146.35
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
OP
|
$47,231.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
906820092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,403.00 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$9,446.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| 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 |
$25,977.05
|
| Rate for Payer: Cash Price |
$25,977.05
|
| Rate for Payer: Cash Price |
$25,977.05
|
| Rate for Payer: Cigna of CA HMO |
$30,700.15
|
| Rate for Payer: Cigna of CA PPO |
$34,950.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$40,146.35
|
| Rate for Payer: Global Benefits Group Commercial |
$28,338.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,403.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,503.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,586.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,335.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$37,784.80
|
| Rate for Payer: Networks By Design Commercial |
$30,700.15
|
| Rate for Payer: Prime Health Services Commercial |
$40,146.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,338.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,338.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
OP
|
$48,598.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,403.00 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$9,719.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| 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 |
$26,728.90
|
| Rate for Payer: Cash Price |
$26,728.90
|
| Rate for Payer: Cash Price |
$26,728.90
|
| Rate for Payer: Cigna of CA HMO |
$31,588.70
|
| Rate for Payer: Cigna of CA PPO |
$35,962.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$41,308.30
|
| Rate for Payer: Global Benefits Group Commercial |
$29,158.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,403.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,586.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,663.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$38,878.40
|
| Rate for Payer: Networks By Design Commercial |
$31,588.70
|
| Rate for Payer: Prime Health Services Commercial |
$41,308.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,158.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,158.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
IP
|
$48,598.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,719.60 |
| Max. Negotiated Rate |
$41,308.30 |
| Rate for Payer: Adventist Health Commercial |
$9,719.60
|
| Rate for Payer: Cash Price |
$26,728.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,439.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19,439.20
|
| Rate for Payer: Galaxy Health WC |
$41,308.30
|
| Rate for Payer: Global Benefits Group Commercial |
$29,158.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,515.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,082.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,663.52
|
| Rate for Payer: Multiplan Commercial |
$38,878.40
|
| Rate for Payer: Networks By Design Commercial |
$31,588.70
|
| Rate for Payer: Prime Health Services Commercial |
$41,308.30
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
IP
|
$38,079.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,615.80 |
| Max. Negotiated Rate |
$32,367.15 |
| Rate for Payer: Adventist Health Commercial |
$7,615.80
|
| Rate for Payer: Cash Price |
$20,943.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,231.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,231.60
|
| Rate for Payer: Galaxy Health WC |
$32,367.15
|
| Rate for Payer: Global Benefits Group Commercial |
$22,847.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,398.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,508.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,570.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,138.96
|
| Rate for Payer: Multiplan Commercial |
$30,463.20
|
| Rate for Payer: Networks By Design Commercial |
$24,751.35
|
| Rate for Payer: Prime Health Services Commercial |
$32,367.15
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
OP
|
$37,008.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906820301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,690.13 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$7,401.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| 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 |
$20,354.40
|
| Rate for Payer: Cash Price |
$20,354.40
|
| Rate for Payer: Cash Price |
$20,354.40
|
| Rate for Payer: Cigna of CA HMO |
$24,055.20
|
| Rate for Payer: Cigna of CA PPO |
$27,385.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$31,456.80
|
| Rate for Payer: Global Benefits Group Commercial |
$22,204.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,690.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,881.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$29,606.40
|
| Rate for Payer: Networks By Design Commercial |
$24,055.20
|
| Rate for Payer: Prime Health Services Commercial |
$31,456.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,204.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,204.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
OP
|
$38,079.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,690.13 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$7,615.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| 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 |
$20,943.45
|
| Rate for Payer: Cash Price |
$20,943.45
|
| Rate for Payer: Cash Price |
$20,943.45
|
| Rate for Payer: Cigna of CA HMO |
$24,751.35
|
| Rate for Payer: Cigna of CA PPO |
$28,178.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$32,367.15
|
| Rate for Payer: Global Benefits Group Commercial |
$22,847.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,690.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,398.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,138.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$30,463.20
|
| Rate for Payer: Networks By Design Commercial |
$24,751.35
|
| Rate for Payer: Prime Health Services Commercial |
$32,367.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,847.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,847.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
IP
|
$37,008.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906820301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,401.60 |
| Max. Negotiated Rate |
$31,456.80 |
| Rate for Payer: Adventist Health Commercial |
$7,401.60
|
| Rate for Payer: Cash Price |
$20,354.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,803.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,803.20
|
| Rate for Payer: Galaxy Health WC |
$31,456.80
|
| Rate for Payer: Global Benefits Group Commercial |
$22,204.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,100.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,907.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,881.92
|
| Rate for Payer: Multiplan Commercial |
$29,606.40
|
| Rate for Payer: Networks By Design Commercial |
$24,055.20
|
| Rate for Payer: Prime Health Services Commercial |
$31,456.80
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
OP
|
$21,439.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$617.20 |
| Max. Negotiated Rate |
$18,223.15 |
| Rate for Payer: Adventist Health Commercial |
$4,287.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,223.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,791.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,079.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| 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 |
$11,791.45
|
| Rate for Payer: Cash Price |
$11,791.45
|
| Rate for Payer: Cash Price |
$11,791.45
|
| Rate for Payer: Cigna of CA HMO |
$13,935.35
|
| Rate for Payer: Cigna of CA PPO |
$15,864.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,223.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,223.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18,223.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,575.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,575.60
|
| Rate for Payer: Galaxy Health WC |
$18,223.15
|
| Rate for Payer: Global Benefits Group Commercial |
$12,863.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$617.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,299.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$698.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,270.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,145.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,007.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,007.30
|
| Rate for Payer: Multiplan Commercial |
$17,151.20
|
| Rate for Payer: Networks By Design Commercial |
$13,935.35
|
| Rate for Payer: Prime Health Services Commercial |
$18,223.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,863.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,863.40
|
| 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 |
$18,223.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,223.15
|
| Rate for Payer: Vantage Medical Group Senior |
$18,223.15
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
IP
|
$21,439.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,287.80 |
| Max. Negotiated Rate |
$18,223.15 |
| Rate for Payer: Adventist Health Commercial |
$4,287.80
|
| Rate for Payer: Cash Price |
$11,791.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,575.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,575.60
|
| Rate for Payer: Galaxy Health WC |
$18,223.15
|
| Rate for Payer: Global Benefits Group Commercial |
$12,863.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,299.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,168.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,270.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,145.36
|
| Rate for Payer: Multiplan Commercial |
$17,151.20
|
| Rate for Payer: Networks By Design Commercial |
$13,935.35
|
| Rate for Payer: Prime Health Services Commercial |
$18,223.15
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
IP
|
$20,836.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906820302
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,167.20 |
| Max. Negotiated Rate |
$17,710.60 |
| Rate for Payer: Adventist Health Commercial |
$4,167.20
|
| Rate for Payer: Cash Price |
$11,459.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,334.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,334.40
|
| Rate for Payer: Galaxy Health WC |
$17,710.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,501.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,897.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,938.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,897.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.64
|
| Rate for Payer: Multiplan Commercial |
$16,668.80
|
| Rate for Payer: Networks By Design Commercial |
$13,543.40
|
| Rate for Payer: Prime Health Services Commercial |
$17,710.60
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
OP
|
$20,836.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906820302
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$617.20 |
| Max. Negotiated Rate |
$17,710.60 |
| Rate for Payer: Adventist Health Commercial |
$4,167.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,710.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,459.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,627.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| 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 |
$11,459.80
|
| Rate for Payer: Cash Price |
$11,459.80
|
| Rate for Payer: Cash Price |
$11,459.80
|
| Rate for Payer: Cigna of CA HMO |
$13,543.40
|
| Rate for Payer: Cigna of CA PPO |
$15,418.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,710.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,710.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,710.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,334.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,334.40
|
| Rate for Payer: Galaxy Health WC |
$17,710.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,501.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$617.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,897.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$698.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,897.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,585.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,585.20
|
| Rate for Payer: Multiplan Commercial |
$16,668.80
|
| Rate for Payer: Networks By Design Commercial |
$13,543.40
|
| Rate for Payer: Prime Health Services Commercial |
$17,710.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,501.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,501.60
|
| 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 |
$17,710.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,710.60
|
| Rate for Payer: Vantage Medical Group Senior |
$17,710.60
|
|
|
HC PERSIMMON IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$156.13 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.13
|
| Rate for Payer: Blue Shield of California Commercial |
$44.15
|
| Rate for Payer: Blue Shield of California EPN |
$29.17
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
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 |
$36.30
|
| 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
|
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 |
$6,071.45
|
| 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 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 |
$6,071.45
|
| Rate for Payer: Cash Price |
$6,071.45
|
| 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 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 |
$6,532.90
|
| 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 |
$6,532.90
|
| Rate for Payer: Cash Price |
$6,532.90
|
| 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
|
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 |
$6,421.80
|
| Rate for Payer: Cash Price |
$6,421.80
|
| 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/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 |
$6,421.80
|
| 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 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 |
$4,298.80
|
| Rate for Payer: Cash Price |
$4,298.80
|
| 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 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 |
$4,298.80
|
| 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
|
|
