|
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 |
$33,307.20 |
| Rate for Payer: Adventist Health Commercial |
$7,401.60
|
| Rate for Payer: Cash Price |
$16,653.60
|
| Rate for Payer: Central Health Plan Commercial |
$29,606.40
|
| 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: Health Management Network EPO/PPO |
$33,307.20
|
| 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 |
$7,401.60
|
| Rate for Payer: Multiplan Commercial |
$27,756.00
|
| Rate for Payer: Networks By Design Commercial |
$24,055.20
|
| Rate for Payer: Prime Health Services Commercial |
$31,456.80
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
IP
|
$31,457.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,291.40 |
| Max. Negotiated Rate |
$28,311.30 |
| Rate for Payer: Adventist Health Commercial |
$6,291.40
|
| Rate for Payer: Cash Price |
$14,155.65
|
| Rate for Payer: Central Health Plan Commercial |
$25,165.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,582.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12,582.80
|
| Rate for Payer: Galaxy Health WC |
$26,738.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,874.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,311.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,981.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,985.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,471.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,291.40
|
| Rate for Payer: Multiplan Commercial |
$23,592.75
|
| Rate for Payer: Networks By Design Commercial |
$20,447.05
|
| Rate for Payer: Prime Health Services Commercial |
$26,738.45
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
OP
|
$31,457.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,730.37 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$6,291.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| 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 Exchange |
$7,912.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18,474.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$14,155.65
|
| Rate for Payer: Cash Price |
$14,155.65
|
| Rate for Payer: Cash Price |
$14,155.65
|
| Rate for Payer: Central Health Plan Commercial |
$25,165.60
|
| Rate for Payer: Cigna of CA HMO |
$20,447.05
|
| Rate for Payer: Cigna of CA PPO |
$23,278.18
|
| 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 |
$26,738.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,874.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,311.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,730.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,981.82
|
| 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 |
$6,291.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$23,592.75
|
| Rate for Payer: Networks By Design Commercial |
$20,447.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Prime Health Services Commercial |
$26,738.45
|
| Rate for Payer: Prime Health Services Medicare |
$24,184.76
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,874.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,874.20
|
| 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 TRNSCTH CLSRE EA OCC DVC
|
Facility
|
IP
|
$17,711.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,542.20 |
| Max. Negotiated Rate |
$15,939.90 |
| Rate for Payer: Adventist Health Commercial |
$3,542.20
|
| Rate for Payer: Cash Price |
$7,969.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,168.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,084.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,084.40
|
| Rate for Payer: Galaxy Health WC |
$15,054.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,626.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,939.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,813.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,747.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,963.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,542.20
|
| Rate for Payer: Multiplan Commercial |
$13,283.25
|
| Rate for Payer: Networks By Design Commercial |
$11,512.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,054.35
|
|
|
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 |
$631.89 |
| Max. Negotiated Rate |
$18,752.40 |
| 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 Exchange |
$2,889.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,236.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$9,376.20
|
| Rate for Payer: Cash Price |
$9,376.20
|
| Rate for Payer: Cash Price |
$9,376.20
|
| Rate for Payer: Central Health Plan Commercial |
$16,668.80
|
| 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: Health Management Network EPO/PPO |
$18,752.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$631.89
|
| Rate for Payer: InnovAge PACE Commercial |
$10,418.00
|
| 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 |
$4,167.20
|
| 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 |
$15,627.00
|
| Rate for Payer: Networks By Design Commercial |
$13,543.40
|
| Rate for Payer: Prime Health Services Commercial |
$17,710.60
|
| Rate for Payer: Riverside University Health System MISP |
$8,334.40
|
| 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 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 |
$18,752.40 |
| Rate for Payer: Adventist Health Commercial |
$4,167.20
|
| Rate for Payer: Cash Price |
$9,376.20
|
| Rate for Payer: Central Health Plan Commercial |
$16,668.80
|
| 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: Health Management Network EPO/PPO |
$18,752.40
|
| 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 |
$4,167.20
|
| Rate for Payer: Multiplan Commercial |
$15,627.00
|
| 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
|
$17,711.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$631.89 |
| Max. Negotiated Rate |
$15,939.90 |
| Rate for Payer: Adventist Health Commercial |
$3,542.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,054.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,741.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,283.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,889.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,401.67
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$7,969.95
|
| Rate for Payer: Cash Price |
$7,969.95
|
| Rate for Payer: Cash Price |
$7,969.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,168.80
|
| Rate for Payer: Cigna of CA HMO |
$11,512.15
|
| Rate for Payer: Cigna of CA PPO |
$13,106.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,054.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,054.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,054.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,084.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,084.40
|
| Rate for Payer: Galaxy Health WC |
$15,054.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,626.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,939.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$631.89
|
| Rate for Payer: InnovAge PACE Commercial |
$8,855.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,813.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$698.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,963.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,542.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,397.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,397.70
|
| Rate for Payer: Multiplan Commercial |
$13,283.25
|
| Rate for Payer: Networks By Design Commercial |
$11,512.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,054.35
|
| Rate for Payer: Riverside University Health System MISP |
$7,084.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,626.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,626.60
|
| 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 |
$15,054.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,054.35
|
| Rate for Payer: Vantage Medical Group Senior |
$15,054.35
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$22,242.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,705.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,641.79
|
| 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 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 |
$9,076.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| 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 |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| 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 |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$149.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: InnovAge PACE Commercial |
$13,615.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,242.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,669.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,162.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| 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 |
$9,076.82
|
| 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 |
$9,621.43
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,008.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| 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 |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
OP
|
$33,347.00
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
909022513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$803.00 |
| Max. Negotiated Rate |
$30,012.30 |
| Rate for Payer: Adventist Health Commercial |
$6,669.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,076.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| 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 |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| 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 |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$803.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: InnovAge PACE Commercial |
$13,615.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,242.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$887.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,669.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,162.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| 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 |
$9,076.82
|
| 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 |
$9,621.43
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,008.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| 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 |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$22,242.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,705.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,641.79
|
| 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 |
$2,901.00
|
| 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 |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| 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: 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: InnovAge PACE Commercial |
$16,673.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,242.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,641.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,669.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,342.90
|
| Rate for Payer: Molina Healthcare of CA 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 |
$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 |
$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: 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 Permanente of CA Commercial/Self Funded |
$22,242.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,705.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,641.79
|
| 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
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$115.00 |
| 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 |
$40.08
|
| 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 |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$40.06
|
| 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: 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: 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: InnovAge PACE Commercial |
$7.83
|
| 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 |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 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 |
$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 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: 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 Permanente of CA Commercial/Self Funded |
$6,645.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,795.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,167.10
|
| 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 LIMITED AREA
|
Facility
|
OP
|
$9,963.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
909301483
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,853.28 |
| Max. Negotiated Rate |
$8,966.70 |
| Rate for Payer: Adventist Health Commercial |
$1,992.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,853.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,050.53
|
| 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 Exchange |
$4,775.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,851.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6,047.54
|
| 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 |
$2,779.92
|
| 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 |
$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 |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,658.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: InnovAge PACE Commercial |
$2,779.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,645.32
|
| 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 |
$1,992.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,483.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| 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 |
$1,853.28
|
| Rate for Payer: Prime Health Services Commercial |
$8,468.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,964.48
|
| Rate for Payer: Riverside University Health System MISP |
$2,038.61
|
| 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 |
$1,853.28
|
| 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
|
$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: 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 Permanente of CA Commercial/Self Funded |
$7,149.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,083.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,635.06
|
| 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 SKULL BASE-THIGH
|
Facility
|
OP
|
$10,719.00
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
909301484
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,853.28 |
| Max. Negotiated Rate |
$9,647.10 |
| Rate for Payer: Adventist Health Commercial |
$2,143.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,853.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,509.65
|
| 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 Exchange |
$5,206.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,295.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6,506.43
|
| 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 |
$2,779.92
|
| 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 |
$9,111.15
|
| 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 |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,658.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: InnovAge PACE Commercial |
$2,779.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,149.57
|
| 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 |
$2,143.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,483.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| 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 |
$1,853.28
|
| Rate for Payer: Prime Health Services Commercial |
$9,111.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,964.48
|
| Rate for Payer: Riverside University Health System MISP |
$2,038.61
|
| 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 |
$1,853.28
|
| 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
|
$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: 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 Permanente of CA Commercial/Self Funded |
$7,028.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,014.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,522.40
|
| 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 |
$1,853.28 |
| Max. Negotiated Rate |
$9,483.30 |
| Rate for Payer: Adventist Health Commercial |
$2,107.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,853.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,399.12
|
| 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 Exchange |
$6,195.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,188.38
|
| Rate for Payer: Blue Shield of California Commercial |
$6,395.96
|
| 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 |
$2,779.92
|
| 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 |
$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 |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,658.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: InnovAge PACE Commercial |
$2,779.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,028.18
|
| 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 |
$2,107.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,483.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| 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 |
$1,853.28
|
| Rate for Payer: Prime Health Services Commercial |
$8,956.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,964.48
|
| Rate for Payer: Riverside University Health System MISP |
$2,038.61
|
| 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 |
$1,853.28
|
| 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
|
$7,053.00
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$4,704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,687.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,365.81
|
| 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 |
$6,347.70 |
| Rate for Payer: Adventist Health Commercial |
$1,410.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,853.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,283.29
|
| 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 Exchange |
$4,451.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,142.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,281.17
|
| 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 |
$2,779.92
|
| 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 |
$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 |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: InnovAge PACE Commercial |
$2,779.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,704.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,483.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| 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 |
$1,853.28
|
| Rate for Payer: Prime Health Services Commercial |
$5,995.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,964.48
|
| Rate for Payer: Riverside University Health System MISP |
$2,038.61
|
| 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 |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC PET MYOCARDIAL PERF MULTI FLW
|
Facility
|
OP
|
$12,207.00
|
|
|
Service Code
|
CPT 78492
|
| Hospital Charge Code |
909301613
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,853.28 |
| Max. Negotiated Rate |
$10,986.30 |
| Rate for Payer: Adventist Health Commercial |
$2,441.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,853.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,413.31
|
| 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 Exchange |
$3,561.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,169.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,409.65
|
| 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 |
$2,779.92
|
| 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 |
$10,375.95
|
| 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 |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: InnovAge PACE Commercial |
$2,779.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,650.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,441.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,483.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| 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 |
$1,853.28
|
| Rate for Payer: Prime Health Services Commercial |
$10,375.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,964.48
|
| Rate for Payer: Riverside University Health System MISP |
$2,038.61
|
| 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 |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC PET MYOCARDIAL PERF MULTI FLW
|
Facility
|
IP
|
$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: 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 Permanente of CA Commercial/Self Funded |
$8,142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,650.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,556.13
|
| 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
|
|
