|
HC PET/CT - TUMOR WHOLE BODY
|
Facility
|
OP
|
$13,049.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301485
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,954.68 |
| Max. Negotiated Rate |
$11,744.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,954.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,195.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,709.35
|
| Rate for Payer: Blue Distinction Transplant |
$7,829.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,064.28
|
| Rate for Payer: Blue Shield of California EPN |
$6,341.81
|
| Rate for Payer: Caremore Medicare Advantage |
$1,954.68
|
| Rate for Payer: Cash Price |
$5,872.05
|
| Rate for Payer: Cash Price |
$5,872.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,439.20
|
| Rate for Payer: Cigna of CA HMO |
$8,351.36
|
| Rate for Payer: Cigna of CA PPO |
$9,656.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$11,091.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,829.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,744.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,786.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,225.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: InnovAge PACE Commercial |
$2,932.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,703.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,041.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,609.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,619.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$9,786.75
|
| Rate for Payer: Networks By Design Commercial |
$8,481.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,091.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,071.96
|
| Rate for Payer: Riverside University Health System MISP |
$2,150.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,829.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,829.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET/CT - TUMOR WHOLE BODY
|
Facility
|
IP
|
$13,049.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301485
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,609.80 |
| Max. Negotiated Rate |
$11,744.10 |
| Rate for Payer: Cash Price |
$5,872.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,439.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,219.60
|
| Rate for Payer: Galaxy Health WC |
$11,091.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,829.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,744.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,703.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,971.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,609.80
|
| Rate for Payer: Multiplan Commercial |
$9,786.75
|
| Rate for Payer: Networks By Design Commercial |
$8,481.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,091.65
|
|
|
HC PET METABOLIC BRAIN
|
Facility
|
IP
|
$8,735.00
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
909301636
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,747.00 |
| Max. Negotiated Rate |
$7,861.50 |
| Rate for Payer: Cash Price |
$3,930.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,988.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,494.00
|
| Rate for Payer: Galaxy Health WC |
$7,424.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,241.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,861.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,826.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,328.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,747.00
|
| Rate for Payer: Multiplan Commercial |
$6,551.25
|
| Rate for Payer: Networks By Design Commercial |
$5,677.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,424.75
|
|
|
HC PET METABOLIC BRAIN
|
Facility
|
OP
|
$8,735.00
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
909301636
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,747.00 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,954.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,451.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,160.64
|
| Rate for Payer: Blue Distinction Transplant |
$5,241.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,398.23
|
| Rate for Payer: Blue Shield of California EPN |
$4,245.21
|
| Rate for Payer: Caremore Medicare Advantage |
$1,954.68
|
| Rate for Payer: Cash Price |
$3,930.75
|
| Rate for Payer: Cash Price |
$3,930.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,988.00
|
| Rate for Payer: Cigna of CA HMO |
$5,590.40
|
| Rate for Payer: Cigna of CA PPO |
$6,463.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$7,424.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,241.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,861.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,551.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,225.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: InnovAge PACE Commercial |
$2,932.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,826.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,747.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,619.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$6,551.25
|
| Rate for Payer: Networks By Design Commercial |
$5,677.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,424.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,071.96
|
| Rate for Payer: Riverside University Health System MISP |
$2,150.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,241.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,241.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET MYOCARDIAL PERF MULTI FLW
|
Facility
|
IP
|
$15,117.00
|
|
|
Service Code
|
CPT 78492
|
| Hospital Charge Code |
909301613
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,023.40 |
| Max. Negotiated Rate |
$13,605.30 |
| Rate for Payer: Cash Price |
$6,802.65
|
| Rate for Payer: Central Health Plan Commercial |
$12,093.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,046.80
|
| Rate for Payer: Galaxy Health WC |
$12,849.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,070.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,605.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,083.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,759.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,023.40
|
| Rate for Payer: Multiplan Commercial |
$11,337.75
|
| Rate for Payer: Networks By Design Commercial |
$9,826.05
|
| Rate for Payer: Prime Health Services Commercial |
$12,849.45
|
|
|
HC PET MYOCARDIAL PERF MULTI FLW
|
Facility
|
OP
|
$15,117.00
|
|
|
Service Code
|
CPT 78492
|
| Hospital Charge Code |
909301613
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,954.68 |
| Max. Negotiated Rate |
$13,605.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,954.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,561.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,931.12
|
| Rate for Payer: Blue Distinction Transplant |
$9,070.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9,342.31
|
| Rate for Payer: Blue Shield of California EPN |
$7,346.86
|
| Rate for Payer: Caremore Medicare Advantage |
$1,954.68
|
| Rate for Payer: Cash Price |
$6,802.65
|
| Rate for Payer: Cash Price |
$6,802.65
|
| Rate for Payer: Central Health Plan Commercial |
$12,093.60
|
| Rate for Payer: Cigna of CA HMO |
$9,674.88
|
| Rate for Payer: Cigna of CA PPO |
$11,186.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$12,849.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,070.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,605.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,337.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,225.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: InnovAge PACE Commercial |
$2,932.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,083.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,759.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,023.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,619.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$11,337.75
|
| Rate for Payer: Networks By Design Commercial |
$9,826.05
|
| Rate for Payer: Prime Health Services Commercial |
$12,849.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,071.96
|
| Rate for Payer: Riverside University Health System MISP |
$2,150.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,070.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,070.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET MYOCARDIAL PERF SGL FLW
|
Facility
|
OP
|
$6,207.00
|
|
|
Service Code
|
CPT 78491
|
| Hospital Charge Code |
909301602
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,241.40 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,954.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,038.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,667.10
|
| Rate for Payer: Blue Distinction Transplant |
$3,724.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,835.93
|
| Rate for Payer: Blue Shield of California EPN |
$3,016.60
|
| Rate for Payer: Caremore Medicare Advantage |
$1,954.68
|
| Rate for Payer: Cash Price |
$2,793.15
|
| Rate for Payer: Cash Price |
$2,793.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,965.60
|
| Rate for Payer: Cigna of CA HMO |
$3,972.48
|
| Rate for Payer: Cigna of CA PPO |
$4,593.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$5,275.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,724.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,586.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,655.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,225.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: InnovAge PACE Commercial |
$2,932.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,364.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,241.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,619.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$4,655.25
|
| Rate for Payer: Networks By Design Commercial |
$4,034.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,275.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,071.96
|
| Rate for Payer: Riverside University Health System MISP |
$2,150.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,724.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,724.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET MYOCARDIAL PERF SGL FLW
|
Facility
|
IP
|
$6,207.00
|
|
|
Service Code
|
CPT 78491
|
| Hospital Charge Code |
909301602
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,241.40 |
| Max. Negotiated Rate |
$5,586.30 |
| Rate for Payer: Cash Price |
$2,793.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,965.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,482.80
|
| Rate for Payer: Galaxy Health WC |
$5,275.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,724.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,586.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,364.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,241.40
|
| Rate for Payer: Multiplan Commercial |
$4,655.25
|
| Rate for Payer: Networks By Design Commercial |
$4,034.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,275.95
|
|
|
HC PET SCAN/GAMMA LYMPHOMA
|
Facility
|
IP
|
$13,049.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301467
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,609.80 |
| Max. Negotiated Rate |
$11,744.10 |
| Rate for Payer: Cash Price |
$5,872.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,439.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,219.60
|
| Rate for Payer: Galaxy Health WC |
$11,091.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,829.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,744.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,703.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,971.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,609.80
|
| Rate for Payer: Multiplan Commercial |
$9,786.75
|
| Rate for Payer: Networks By Design Commercial |
$8,481.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,091.65
|
|
|
HC PET SCAN/GAMMA LYMPHOMA
|
Facility
|
OP
|
$13,049.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301467
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,954.68 |
| Max. Negotiated Rate |
$11,744.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,954.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,195.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,709.35
|
| Rate for Payer: Blue Distinction Transplant |
$7,829.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,064.28
|
| Rate for Payer: Blue Shield of California EPN |
$6,341.81
|
| Rate for Payer: Caremore Medicare Advantage |
$1,954.68
|
| Rate for Payer: Cash Price |
$5,872.05
|
| Rate for Payer: Cash Price |
$5,872.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,439.20
|
| Rate for Payer: Cigna of CA HMO |
$8,351.36
|
| Rate for Payer: Cigna of CA PPO |
$9,656.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$11,091.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,829.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,744.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,786.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,225.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: InnovAge PACE Commercial |
$2,932.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,703.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,041.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,609.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,619.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$9,786.75
|
| Rate for Payer: Networks By Design Commercial |
$8,481.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,091.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,071.96
|
| Rate for Payer: Riverside University Health System MISP |
$2,150.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,829.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,829.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET SCAN SKULL BASE TO MID THIGH
|
Facility
|
OP
|
$9,459.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
909301481
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,891.80 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,954.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,716.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,588.38
|
| Rate for Payer: Blue Distinction Transplant |
$5,675.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,845.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,597.07
|
| Rate for Payer: Caremore Medicare Advantage |
$1,954.68
|
| Rate for Payer: Cash Price |
$4,256.55
|
| Rate for Payer: Cash Price |
$4,256.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,567.20
|
| Rate for Payer: Cigna of CA HMO |
$6,053.76
|
| Rate for Payer: Cigna of CA PPO |
$6,999.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$8,040.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,675.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,513.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,094.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,225.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: InnovAge PACE Commercial |
$2,932.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,309.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,851.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,891.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,619.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$7,094.25
|
| Rate for Payer: Networks By Design Commercial |
$6,148.35
|
| Rate for Payer: Prime Health Services Commercial |
$8,040.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,071.96
|
| Rate for Payer: Riverside University Health System MISP |
$2,150.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,675.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,675.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET SCAN SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$9,459.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
909301481
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,891.80 |
| Max. Negotiated Rate |
$8,513.10 |
| Rate for Payer: Cash Price |
$4,256.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,567.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,783.60
|
| Rate for Payer: Galaxy Health WC |
$8,040.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,675.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,513.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,309.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,603.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,891.80
|
| Rate for Payer: Multiplan Commercial |
$7,094.25
|
| Rate for Payer: Networks By Design Commercial |
$6,148.35
|
| Rate for Payer: Prime Health Services Commercial |
$8,040.15
|
|
|
HC PET SCAN WHOLE BODY
|
Facility
|
OP
|
$12,514.00
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
909301482
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,954.68 |
| Max. Negotiated Rate |
$11,262.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,954.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,705.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,393.27
|
| Rate for Payer: Blue Distinction Transplant |
$7,508.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,733.65
|
| Rate for Payer: Blue Shield of California EPN |
$6,081.80
|
| Rate for Payer: Caremore Medicare Advantage |
$1,954.68
|
| Rate for Payer: Cash Price |
$5,631.30
|
| Rate for Payer: Cash Price |
$5,631.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,011.20
|
| Rate for Payer: Cigna of CA HMO |
$8,008.96
|
| Rate for Payer: Cigna of CA PPO |
$9,260.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$10,636.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,508.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,262.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,385.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,225.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: InnovAge PACE Commercial |
$2,932.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,851.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,502.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,619.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$9,385.50
|
| Rate for Payer: Networks By Design Commercial |
$8,134.10
|
| Rate for Payer: Prime Health Services Commercial |
$10,636.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,071.96
|
| Rate for Payer: Riverside University Health System MISP |
$2,150.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,508.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,508.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET SCAN WHOLE BODY
|
Facility
|
IP
|
$12,514.00
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
909301482
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,502.80 |
| Max. Negotiated Rate |
$11,262.60 |
| Rate for Payer: Cash Price |
$5,631.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,011.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,005.60
|
| Rate for Payer: Galaxy Health WC |
$10,636.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,508.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,262.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,767.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,502.80
|
| Rate for Payer: Multiplan Commercial |
$9,385.50
|
| Rate for Payer: Networks By Design Commercial |
$8,134.10
|
| Rate for Payer: Prime Health Services Commercial |
$10,636.90
|
|
|
HC PET TUMOR LIMITED
|
Facility
|
IP
|
$9,459.00
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
909301480
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,891.80 |
| Max. Negotiated Rate |
$8,513.10 |
| Rate for Payer: Cash Price |
$4,256.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,567.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,783.60
|
| Rate for Payer: Galaxy Health WC |
$8,040.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,675.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,513.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,309.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,603.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,891.80
|
| Rate for Payer: Multiplan Commercial |
$7,094.25
|
| Rate for Payer: Networks By Design Commercial |
$6,148.35
|
| Rate for Payer: Prime Health Services Commercial |
$8,040.15
|
|
|
HC PET TUMOR LIMITED
|
Facility
|
OP
|
$9,459.00
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
909301480
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,774.15 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,774.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,285.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,588.38
|
| Rate for Payer: Blue Distinction Transplant |
$5,675.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,845.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,597.07
|
| Rate for Payer: Caremore Medicare Advantage |
$1,774.15
|
| Rate for Payer: Cash Price |
$4,256.55
|
| Rate for Payer: Cash Price |
$4,256.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,567.20
|
| Rate for Payer: Cigna of CA HMO |
$6,053.76
|
| Rate for Payer: Cigna of CA PPO |
$6,999.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$8,040.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,675.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,513.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,094.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,909.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,927.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: InnovAge PACE Commercial |
$2,661.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,309.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,851.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,891.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,377.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$7,094.25
|
| Rate for Payer: Networks By Design Commercial |
$6,148.35
|
| Rate for Payer: Prime Health Services Commercial |
$8,040.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,880.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,951.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,675.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,675.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
OP
|
$2,595.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906820068
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$167.10 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$593.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,205.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,427.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,427.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,256.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,533.13
|
| Rate for Payer: Blue Distinction Transplant |
$1,557.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,076.00
|
| Rate for Payer: Cigna of CA PPO |
$1,920.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,205.75
|
| Rate for Payer: Dignity Health Media |
$2,205.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,205.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,038.00
|
| Rate for Payer: Galaxy Health WC |
$2,205.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,335.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,946.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$908.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,730.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.00
|
| Rate for Payer: Multiplan Commercial |
$1,946.25
|
| Rate for Payer: Networks By Design Commercial |
$1,686.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,205.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,038.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,557.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,205.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,205.75
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
OP
|
$2,595.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906811410
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$167.10 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$593.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,205.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,427.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,427.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,256.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,533.13
|
| Rate for Payer: Blue Distinction Transplant |
$1,557.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,076.00
|
| Rate for Payer: Cigna of CA PPO |
$1,920.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,205.75
|
| Rate for Payer: Dignity Health Media |
$2,205.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,205.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,038.00
|
| Rate for Payer: Galaxy Health WC |
$2,205.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,335.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,946.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$908.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,730.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.00
|
| Rate for Payer: Multiplan Commercial |
$1,946.25
|
| Rate for Payer: Networks By Design Commercial |
$1,686.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,205.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,038.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,557.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,205.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,205.75
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
IP
|
$2,595.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906820068
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$519.00 |
| Max. Negotiated Rate |
$2,335.50 |
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,076.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Galaxy Health WC |
$2,205.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,335.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,730.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$988.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.00
|
| Rate for Payer: Multiplan Commercial |
$1,946.25
|
| Rate for Payer: Networks By Design Commercial |
$1,686.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,205.75
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
IP
|
$2,595.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906811410
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$519.00 |
| Max. Negotiated Rate |
$2,335.50 |
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,076.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Galaxy Health WC |
$2,205.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,335.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,730.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$988.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.00
|
| Rate for Payer: Multiplan Commercial |
$1,946.25
|
| Rate for Payer: Networks By Design Commercial |
$1,686.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,205.75
|
|
|
HC PHARM-CHLORIDE IV SOLUTION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
900912107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC PHARM-CHLORIDE IV SOLUTION
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
900912107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.82
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Media |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Riverside University Health System MISP |
$8.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC PHARM-GLUCOSE IV SOLUTION
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 81099
|
| Hospital Charge Code |
900912109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC PHARM-GLUCOSE IV SOLUTION
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 81099
|
| Hospital Charge Code |
900912109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.04
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.45
|
| Rate for Payer: Dignity Health Media |
$14.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.80
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Riverside University Health System MISP |
$6.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.45
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC PHARM-PHOSPHORUS IV SOLUTION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
900912108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
