|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
OP
|
$33,347.00
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
909022514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.85 |
| Max. Negotiated Rate |
$30,012.30 |
| Rate for Payer: Adventist Health Commercial |
$6,669.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,332.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$15,006.15
|
| Rate for Payer: Cash Price |
$15,006.15
|
| Rate for Payer: Cash Price |
$15,006.15
|
| Rate for Payer: Central Health Plan Commercial |
$26,677.60
|
| Rate for Payer: Cigna of CA HMO |
$21,342.08
|
| Rate for Payer: Cigna of CA PPO |
$24,676.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,342.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Galaxy Health WC |
$28,344.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,008.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,012.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$149.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,175.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,065.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,669.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$25,010.25
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$21,675.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$28,344.95
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,008.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,673.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
IP
|
$33,347.00
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
909022514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,669.40 |
| Max. Negotiated Rate |
$30,012.30 |
| Rate for Payer: Adventist Health Commercial |
$6,669.40
|
| Rate for Payer: Cash Price |
$15,006.15
|
| Rate for Payer: Central Health Plan Commercial |
$26,677.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,342.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,338.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13,338.80
|
| Rate for Payer: Galaxy Health WC |
$28,344.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,008.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,012.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,175.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,674.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,669.40
|
| Rate for Payer: Multiplan Commercial |
$25,010.25
|
| Rate for Payer: Networks By Design Commercial |
$21,675.55
|
| Rate for Payer: Prime Health Services Commercial |
$28,344.95
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
OP
|
$33,347.00
|
|
|
Service Code
|
CPT 22515
|
| Hospital Charge Code |
909022515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$335.55 |
| Max. Negotiated Rate |
$30,012.30 |
| Rate for Payer: Adventist Health Commercial |
$6,669.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28,344.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,340.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,010.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$15,006.15
|
| Rate for Payer: Cash Price |
$15,006.15
|
| Rate for Payer: Cash Price |
$15,006.15
|
| Rate for Payer: Central Health Plan Commercial |
$26,677.60
|
| Rate for Payer: Cigna of CA HMO |
$21,342.08
|
| Rate for Payer: Cigna of CA PPO |
$24,676.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28,344.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$28,344.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,344.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,342.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,338.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13,338.80
|
| Rate for Payer: Galaxy Health WC |
$28,344.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,008.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,012.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$335.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,175.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$370.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,674.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,669.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,342.90
|
| Rate for Payer: Multiplan Commercial |
$25,010.25
|
| Rate for Payer: Networks By Design Commercial |
$21,675.55
|
| Rate for Payer: Prime Health Services Commercial |
$28,344.95
|
| Rate for Payer: Riverside University Health System MISP |
$13,338.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,008.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,673.50
|
| 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 |
$28,344.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28,344.95
|
| Rate for Payer: Vantage Medical Group Senior |
$28,344.95
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
IP
|
$33,347.00
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
909022513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,669.40 |
| Max. Negotiated Rate |
$30,012.30 |
| Rate for Payer: Adventist Health Commercial |
$6,669.40
|
| Rate for Payer: Cash Price |
$15,006.15
|
| Rate for Payer: Central Health Plan Commercial |
$26,677.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,342.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,338.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13,338.80
|
| Rate for Payer: Galaxy Health WC |
$28,344.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,008.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,012.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,175.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,674.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,669.40
|
| Rate for Payer: Multiplan Commercial |
$25,010.25
|
| Rate for Payer: Networks By Design Commercial |
$21,675.55
|
| Rate for Payer: Prime Health Services Commercial |
$28,344.95
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
IP
|
$33,347.00
|
|
|
Service Code
|
CPT 22515
|
| Hospital Charge Code |
909022515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,669.40 |
| Max. Negotiated Rate |
$30,012.30 |
| Rate for Payer: Adventist Health Commercial |
$6,669.40
|
| Rate for Payer: Cash Price |
$15,006.15
|
| Rate for Payer: Central Health Plan Commercial |
$26,677.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,342.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,338.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13,338.80
|
| Rate for Payer: Galaxy Health WC |
$28,344.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,008.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,012.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,175.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,674.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,669.40
|
| Rate for Payer: Multiplan Commercial |
$25,010.25
|
| Rate for Payer: Networks By Design Commercial |
$21,675.55
|
| Rate for Payer: Prime Health Services Commercial |
$28,344.95
|
|
|
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 |
$59.40 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| 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: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
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 |
$159.88 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| 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 Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.88
|
| Rate for Payer: Blue Shield of California Commercial |
$41.58
|
| Rate for Payer: Blue Shield of California EPN |
$26.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| 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 PET/CT - TUMOR LIMITED AREA
|
Facility
|
OP
|
$9,963.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
909301483
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,839.15 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Commercial |
$1,992.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,839.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,839.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,775.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,795.48
|
| Rate for Payer: Blue Shield of California Commercial |
$6,276.69
|
| Rate for Payer: Blue Shield of California EPN |
$3,955.31
|
| Rate for Payer: Cash Price |
$4,483.35
|
| Rate for Payer: Cash Price |
$4,483.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,970.40
|
| Rate for Payer: Cigna of CA HMO |
$6,376.32
|
| Rate for Payer: Cigna of CA PPO |
$7,372.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,839.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,974.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,034.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,023.07
|
| Rate for Payer: Galaxy Health WC |
$8,468.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,977.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,966.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,016.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,658.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,326.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,041.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,574.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,992.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,464.46
|
| Rate for Payer: Multiplan Commercial |
$7,472.25
|
| Rate for Payer: Networks By Design Commercial |
$6,475.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,468.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,949.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,023.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,977.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,977.80
|
| 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 |
$1,839.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,839.15
|
|
|
HC PET/CT - TUMOR LIMITED AREA
|
Facility
|
IP
|
$9,963.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
909301483
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,992.60 |
| Max. Negotiated Rate |
$8,966.70 |
| Rate for Payer: Adventist Health Commercial |
$1,992.60
|
| Rate for Payer: Cash Price |
$4,483.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,970.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,974.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,985.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,985.20
|
| Rate for Payer: Galaxy Health WC |
$8,468.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,977.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,966.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,326.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,878.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,992.60
|
| Rate for Payer: Multiplan Commercial |
$7,472.25
|
| Rate for Payer: Networks By Design Commercial |
$6,475.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,468.55
|
|
|
HC PET/CT -TUMOR SKULL BASE-THIGH
|
Facility
|
OP
|
$10,719.00
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
909301484
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,839.15 |
| Max. Negotiated Rate |
$9,647.10 |
| Rate for Payer: Adventist Health Commercial |
$2,143.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,839.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,839.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,206.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,235.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6,752.97
|
| Rate for Payer: Blue Shield of California EPN |
$4,255.44
|
| Rate for Payer: Cash Price |
$4,823.55
|
| Rate for Payer: Cash Price |
$4,823.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,575.20
|
| Rate for Payer: Cigna of CA HMO |
$6,860.16
|
| Rate for Payer: Cigna of CA PPO |
$7,932.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,839.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,503.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,034.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,023.07
|
| Rate for Payer: Galaxy Health WC |
$9,111.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,431.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,647.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,016.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,658.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,806.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,041.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,574.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,143.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,464.46
|
| Rate for Payer: Multiplan Commercial |
$8,039.25
|
| Rate for Payer: Networks By Design Commercial |
$6,967.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,111.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,949.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,023.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,431.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,431.40
|
| 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 |
$1,839.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,839.15
|
|
|
HC PET/CT -TUMOR SKULL BASE-THIGH
|
Facility
|
IP
|
$10,719.00
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
909301484
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,143.80 |
| Max. Negotiated Rate |
$9,647.10 |
| Rate for Payer: Adventist Health Commercial |
$2,143.80
|
| Rate for Payer: Cash Price |
$4,823.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,575.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,503.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,287.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,287.60
|
| Rate for Payer: Galaxy Health WC |
$9,111.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,431.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,647.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,806.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,324.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,143.80
|
| Rate for Payer: Multiplan Commercial |
$8,039.25
|
| Rate for Payer: Networks By Design Commercial |
$6,967.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,111.15
|
|
|
HC PET/CT - TUMOR WHOLE BODY
|
Facility
|
IP
|
$10,537.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301485
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,107.40 |
| Max. Negotiated Rate |
$9,483.30 |
| Rate for Payer: Adventist Health Commercial |
$2,107.40
|
| Rate for Payer: Cash Price |
$4,741.65
|
| Rate for Payer: Central Health Plan Commercial |
$8,429.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,375.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,214.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,214.80
|
| Rate for Payer: Galaxy Health WC |
$8,956.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,322.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,483.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,690.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,216.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,107.40
|
| Rate for Payer: Multiplan Commercial |
$7,902.75
|
| Rate for Payer: Networks By Design Commercial |
$6,849.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,956.45
|
|
|
HC PET/CT - TUMOR WHOLE BODY
|
Facility
|
OP
|
$10,537.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301485
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,839.15 |
| Max. Negotiated Rate |
$9,483.30 |
| Rate for Payer: Adventist Health Commercial |
$2,107.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,839.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,839.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,195.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,129.37
|
| Rate for Payer: Blue Shield of California Commercial |
$6,638.31
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.19
|
| Rate for Payer: Cash Price |
$4,741.65
|
| Rate for Payer: Cash Price |
$4,741.65
|
| Rate for Payer: Central Health Plan Commercial |
$8,429.60
|
| Rate for Payer: Cigna of CA HMO |
$6,743.68
|
| Rate for Payer: Cigna of CA PPO |
$7,797.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,839.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,375.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,034.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,023.07
|
| Rate for Payer: Galaxy Health WC |
$8,956.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,322.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,483.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,016.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,658.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,690.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,041.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,574.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,107.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,464.46
|
| Rate for Payer: Multiplan Commercial |
$7,902.75
|
| Rate for Payer: Networks By Design Commercial |
$6,849.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,956.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,949.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,023.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,322.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,322.20
|
| 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 |
$1,839.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,839.15
|
|
|
HC PET METABOLIC BRAIN
|
Facility
|
IP
|
$7,053.00
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
909301636
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,410.60 |
| Max. Negotiated Rate |
$6,347.70 |
| Rate for Payer: Adventist Health Commercial |
$1,410.60
|
| Rate for Payer: Cash Price |
$3,173.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,642.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,937.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,821.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,821.20
|
| Rate for Payer: Galaxy Health WC |
$5,995.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,231.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,347.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,478.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,161.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.60
|
| Rate for Payer: Multiplan Commercial |
$5,289.75
|
| Rate for Payer: Networks By Design Commercial |
$4,584.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,995.05
|
|
|
HC PET METABOLIC BRAIN
|
Facility
|
OP
|
$7,053.00
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
909301636
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,410.60 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Commercial |
$1,410.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,839.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,839.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,451.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,102.73
|
| Rate for Payer: Blue Shield of California Commercial |
$4,443.39
|
| Rate for Payer: Blue Shield of California EPN |
$2,800.04
|
| Rate for Payer: Cash Price |
$3,173.85
|
| Rate for Payer: Cash Price |
$3,173.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,642.40
|
| Rate for Payer: Cigna of CA HMO |
$4,513.92
|
| Rate for Payer: Cigna of CA PPO |
$5,219.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,839.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,937.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,034.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,023.07
|
| Rate for Payer: Galaxy Health WC |
$5,995.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,231.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,347.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,016.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,478.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,574.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,464.46
|
| Rate for Payer: Multiplan Commercial |
$5,289.75
|
| Rate for Payer: Networks By Design Commercial |
$4,584.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,995.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,949.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,023.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,231.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,231.80
|
| 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 |
$1,839.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,839.15
|
|
|
HC PET MYOCARDIAL PERF MULTI FLW
|
Facility
|
IP
|
$12,207.00
|
|
|
Service Code
|
CPT 78492
|
| Hospital Charge Code |
909301613
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,441.40 |
| Max. Negotiated Rate |
$10,986.30 |
| Rate for Payer: Adventist Health Commercial |
$2,441.40
|
| Rate for Payer: Cash Price |
$5,493.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,765.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,544.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,882.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,882.80
|
| Rate for Payer: Galaxy Health WC |
$10,375.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,324.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,986.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,751.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,202.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,441.40
|
| Rate for Payer: Multiplan Commercial |
$9,155.25
|
| Rate for Payer: Networks By Design Commercial |
$7,934.55
|
| Rate for Payer: Prime Health Services Commercial |
$10,375.95
|
|
|
HC PET MYOCARDIAL PERF MULTI FLW
|
Facility
|
OP
|
$12,207.00
|
|
|
Service Code
|
CPT 78492
|
| Hospital Charge Code |
909301613
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,839.15 |
| Max. Negotiated Rate |
$10,986.30 |
| Rate for Payer: Adventist Health Commercial |
$2,441.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,839.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,839.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,561.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,100.81
|
| Rate for Payer: Blue Shield of California Commercial |
$7,690.41
|
| Rate for Payer: Blue Shield of California EPN |
$4,846.18
|
| Rate for Payer: Cash Price |
$5,493.15
|
| Rate for Payer: Cash Price |
$5,493.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,765.60
|
| Rate for Payer: Cigna of CA HMO |
$7,812.48
|
| Rate for Payer: Cigna of CA PPO |
$9,033.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,839.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,544.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,034.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,023.07
|
| Rate for Payer: Galaxy Health WC |
$10,375.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,324.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,986.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,016.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,751.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,431.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,574.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,441.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,464.46
|
| Rate for Payer: Multiplan Commercial |
$9,155.25
|
| Rate for Payer: Networks By Design Commercial |
$7,934.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,375.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,949.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,023.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,324.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,324.20
|
| 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 |
$1,839.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,839.15
|
|
|
HC PET MYOCARDIAL PERF SGL FLW
|
Facility
|
OP
|
$5,012.00
|
|
|
Service Code
|
CPT 78491
|
| Hospital Charge Code |
909301602
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,002.40 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Commercial |
$1,002.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,839.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,839.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,038.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,915.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3,157.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,989.76
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,009.60
|
| Rate for Payer: Cigna of CA HMO |
$3,207.68
|
| Rate for Payer: Cigna of CA PPO |
$3,708.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,839.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,508.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,034.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,023.07
|
| Rate for Payer: Galaxy Health WC |
$4,260.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,510.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,016.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,182.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,819.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,574.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,464.46
|
| Rate for Payer: Multiplan Commercial |
$3,759.00
|
| Rate for Payer: Networks By Design Commercial |
$3,257.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,260.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,949.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,023.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,007.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,007.20
|
| 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 |
$1,839.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,839.15
|
|
|
HC PET MYOCARDIAL PERF SGL FLW
|
Facility
|
IP
|
$5,012.00
|
|
|
Service Code
|
CPT 78491
|
| Hospital Charge Code |
909301602
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,002.40 |
| Max. Negotiated Rate |
$4,510.80 |
| Rate for Payer: Adventist Health Commercial |
$1,002.40
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,009.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,508.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,004.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,004.80
|
| Rate for Payer: Galaxy Health WC |
$4,260.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,510.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,182.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,957.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.40
|
| Rate for Payer: Multiplan Commercial |
$3,759.00
|
| Rate for Payer: Networks By Design Commercial |
$3,257.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,260.20
|
|
|
HC PET SCAN/GAMMA LYMPHOMA
|
Facility
|
OP
|
$10,537.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301467
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,839.15 |
| Max. Negotiated Rate |
$9,483.30 |
| Rate for Payer: Adventist Health Commercial |
$2,107.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,839.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,839.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,195.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,129.37
|
| Rate for Payer: Blue Shield of California Commercial |
$6,638.31
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.19
|
| Rate for Payer: Cash Price |
$4,741.65
|
| Rate for Payer: Cash Price |
$4,741.65
|
| Rate for Payer: Central Health Plan Commercial |
$8,429.60
|
| Rate for Payer: Cigna of CA HMO |
$6,743.68
|
| Rate for Payer: Cigna of CA PPO |
$7,797.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,839.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,375.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,034.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,023.07
|
| Rate for Payer: Galaxy Health WC |
$8,956.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,322.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,483.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,016.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,658.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,690.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,041.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,574.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,107.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,464.46
|
| Rate for Payer: Multiplan Commercial |
$7,902.75
|
| Rate for Payer: Networks By Design Commercial |
$6,849.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,956.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,949.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,023.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,322.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,322.20
|
| 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 |
$1,839.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,839.15
|
|
|
HC PET SCAN/GAMMA LYMPHOMA
|
Facility
|
IP
|
$10,537.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301467
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,107.40 |
| Max. Negotiated Rate |
$9,483.30 |
| Rate for Payer: Adventist Health Commercial |
$2,107.40
|
| Rate for Payer: Cash Price |
$4,741.65
|
| Rate for Payer: Central Health Plan Commercial |
$8,429.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,375.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,214.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,214.80
|
| Rate for Payer: Galaxy Health WC |
$8,956.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,322.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,483.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,690.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,216.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,107.40
|
| Rate for Payer: Multiplan Commercial |
$7,902.75
|
| Rate for Payer: Networks By Design Commercial |
$6,849.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,956.45
|
|
|
HC PET SCAN SKULL BASE TO MID THIGH
|
Facility
|
OP
|
$7,638.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
909301481
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,527.60 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Commercial |
$1,527.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,839.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,839.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,716.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,443.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4,811.94
|
| Rate for Payer: Blue Shield of California EPN |
$3,032.29
|
| Rate for Payer: Cash Price |
$3,437.10
|
| Rate for Payer: Cash Price |
$3,437.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,110.40
|
| Rate for Payer: Cigna of CA HMO |
$4,888.32
|
| Rate for Payer: Cigna of CA PPO |
$5,652.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,839.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,346.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,034.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,023.07
|
| Rate for Payer: Galaxy Health WC |
$6,492.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,582.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,874.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,016.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,486.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,850.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,851.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,574.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,464.46
|
| Rate for Payer: Multiplan Commercial |
$5,728.50
|
| Rate for Payer: Networks By Design Commercial |
$4,964.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,492.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,949.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,023.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,582.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,582.80
|
| 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 |
$1,839.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,839.15
|
|
|
HC PET SCAN SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$7,638.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
909301481
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,527.60 |
| Max. Negotiated Rate |
$6,874.20 |
| Rate for Payer: Adventist Health Commercial |
$1,527.60
|
| Rate for Payer: Cash Price |
$3,437.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,110.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,346.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,055.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,055.20
|
| Rate for Payer: Galaxy Health WC |
$6,492.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,582.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,874.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,850.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,506.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.60
|
| Rate for Payer: Multiplan Commercial |
$5,728.50
|
| Rate for Payer: Networks By Design Commercial |
$4,964.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,492.30
|
|
|
HC PET SCAN WHOLE BODY
|
Facility
|
OP
|
$10,105.00
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
909301482
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,839.15 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Commercial |
$2,021.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,839.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,839.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,705.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,878.08
|
| Rate for Payer: Blue Shield of California Commercial |
$6,366.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,011.68
|
| Rate for Payer: Cash Price |
$4,547.25
|
| Rate for Payer: Cash Price |
$4,547.25
|
| Rate for Payer: Central Health Plan Commercial |
$8,084.00
|
| Rate for Payer: Cigna of CA HMO |
$6,467.20
|
| Rate for Payer: Cigna of CA PPO |
$7,477.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,839.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,073.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,034.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,023.07
|
| Rate for Payer: Galaxy Health WC |
$8,589.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,063.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,094.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,016.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,486.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,416.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,851.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,574.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,464.46
|
| Rate for Payer: Multiplan Commercial |
$7,578.75
|
| Rate for Payer: Networks By Design Commercial |
$6,568.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,589.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,949.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,023.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,063.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,063.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,839.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,839.15
|
|
|
HC PET SCAN WHOLE BODY
|
Facility
|
IP
|
$10,105.00
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
909301482
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,021.00 |
| Max. Negotiated Rate |
$9,094.50 |
| Rate for Payer: Adventist Health Commercial |
$2,021.00
|
| Rate for Payer: Cash Price |
$4,547.25
|
| Rate for Payer: Central Health Plan Commercial |
$8,084.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,073.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,042.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,042.00
|
| Rate for Payer: Galaxy Health WC |
$8,589.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,063.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,094.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,416.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,961.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.00
|
| Rate for Payer: Multiplan Commercial |
$7,578.75
|
| Rate for Payer: Networks By Design Commercial |
$6,568.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,589.25
|
|
