|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
OP
|
$49,717.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
906820092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,302.79 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$9,943.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34,155.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,316.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,774.82
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,302.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,998.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,429.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$37,287.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,042.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,173.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
IP
|
$41,672.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$31,254.00 |
| Rate for Payer: Adventist Health Commercial |
$8,334.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,628.66
|
| Rate for Payer: Cash Price |
$18,752.40
|
| Rate for Payer: Cash Price |
$18,752.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,542.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,418.00
|
| Rate for Payer: Multiplan Commercial |
$31,254.00
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
IP
|
$38,956.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906820301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$29,217.00 |
| Rate for Payer: Adventist Health Commercial |
$7,791.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,762.77
|
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,051.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,739.00
|
| Rate for Payer: Multiplan Commercial |
$29,217.00
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
OP
|
$41,672.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,569.41 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$8,334.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,628.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$18,752.40
|
| Rate for Payer: Cash Price |
$18,752.40
|
| Rate for Payer: Cash Price |
$18,752.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,086.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,794.97
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,569.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,542.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,418.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$31,254.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,042.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,173.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
OP
|
$38,956.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906820301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,569.41 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$7,791.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,762.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,321.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,113.76
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,569.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,051.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,739.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$29,217.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,042.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,173.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
IP
|
$21,933.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906820302
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,969.87 |
| Max. Negotiated Rate |
$16,449.75 |
| Rate for Payer: Adventist Health Commercial |
$4,386.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,067.97
|
| Rate for Payer: Cash Price |
$9,869.85
|
| Rate for Payer: Cash Price |
$9,869.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,969.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,483.25
|
| Rate for Payer: Multiplan Commercial |
$16,449.75
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
OP
|
$20,836.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$573.11 |
| Max. Negotiated Rate |
$17,710.60 |
| Rate for Payer: Adventist Health Commercial |
$4,167.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,314.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,710.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,459.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,627.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| 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: Cigna of CA HMO/PPO |
$7,340.00
|
| 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 Senior |
$17,710.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,543.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,897.48
|
| Rate for Payer: Heritage Provider Network Senior |
$12,897.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$573.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,042.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,771.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,209.00
|
| Rate for Payer: Multiplan Commercial |
$15,627.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| 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 |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,771.32 |
| Max. Negotiated Rate |
$15,627.00 |
| Rate for Payer: Adventist Health Commercial |
$4,167.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,314.33
|
| Rate for Payer: Cash Price |
$9,376.20
|
| Rate for Payer: Cash Price |
$9,376.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,771.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,209.00
|
| Rate for Payer: Multiplan Commercial |
$15,627.00
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
OP
|
$21,933.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906820302
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$573.11 |
| Max. Negotiated Rate |
$18,643.05 |
| Rate for Payer: Adventist Health Commercial |
$4,386.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,067.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,643.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,063.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,449.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$9,869.85
|
| Rate for Payer: Cash Price |
$9,869.85
|
| Rate for Payer: Cash Price |
$9,869.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,643.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,643.05
|
| Rate for Payer: Dignity Health Senior |
$18,643.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,256.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,576.53
|
| Rate for Payer: Heritage Provider Network Senior |
$13,576.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$573.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,571.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,969.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,483.25
|
| Rate for Payer: Multiplan Commercial |
$16,449.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,643.05
|
| Rate for Payer: Vantage Medical Group Senior |
$18,643.05
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
IP
|
$43,985.00
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
909022513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$32,988.75 |
| Rate for Payer: Adventist Health Commercial |
$8,797.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30,217.70
|
| Rate for Payer: Cash Price |
$19,793.25
|
| Rate for Payer: Cash Price |
$19,793.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,961.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,996.25
|
| Rate for Payer: Multiplan Commercial |
$32,988.75
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
OP
|
$29,324.00
|
|
|
Service Code
|
CPT 22515
|
| Hospital Charge Code |
909022515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.34 |
| Max. Negotiated Rate |
$24,925.40 |
| Rate for Payer: Adventist Health Commercial |
$5,864.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,145.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,925.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,128.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,993.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$13,195.80
|
| Rate for Payer: Cash Price |
$13,195.80
|
| Rate for Payer: Cash Price |
$13,195.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,060.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,925.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,925.40
|
| Rate for Payer: Dignity Health Senior |
$24,925.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,151.56
|
| Rate for Payer: Heritage Provider Network Senior |
$18,151.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$304.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14,134.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,307.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,331.00
|
| Rate for Payer: Multiplan Commercial |
$21,993.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,925.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24,925.40
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
IP
|
$29,324.00
|
|
|
Service Code
|
CPT 22515
|
| Hospital Charge Code |
909022515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$21,993.00 |
| Rate for Payer: Adventist Health Commercial |
$5,864.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,145.59
|
| Rate for Payer: Cash Price |
$13,195.80
|
| Rate for Payer: Cash Price |
$13,195.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,307.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,331.00
|
| Rate for Payer: Multiplan Commercial |
$21,993.00
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
OP
|
$43,985.00
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
909022514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$135.91 |
| Max. Negotiated Rate |
$32,988.75 |
| Rate for Payer: Adventist Health Commercial |
$8,797.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30,217.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$19,793.25
|
| Rate for Payer: Cash Price |
$19,793.25
|
| Rate for Payer: Cash Price |
$19,793.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28,590.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$27,226.72
|
| Rate for Payer: Heritage Provider Network Senior |
$10,994.39
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,983.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,961.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,996.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: Multiplan Commercial |
$32,988.75
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,832.38
|
| Rate for Payer: TriValley Medical Group Senior |
$9,832.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
OP
|
$43,985.00
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
909022513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$728.30 |
| Max. Negotiated Rate |
$32,988.75 |
| Rate for Payer: Adventist Health Commercial |
$8,797.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30,217.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$19,793.25
|
| Rate for Payer: Cash Price |
$19,793.25
|
| Rate for Payer: Cash Price |
$19,793.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28,590.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$27,226.72
|
| Rate for Payer: Heritage Provider Network Senior |
$10,994.39
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$728.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,983.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,961.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,996.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: Multiplan Commercial |
$32,988.75
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,832.38
|
| Rate for Payer: TriValley Medical Group Senior |
$9,832.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
IP
|
$43,985.00
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
909022514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$32,988.75 |
| Rate for Payer: Adventist Health Commercial |
$8,797.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30,217.70
|
| Rate for Payer: Cash Price |
$19,793.25
|
| Rate for Payer: Cash Price |
$19,793.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,961.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,996.25
|
| Rate for Payer: Multiplan Commercial |
$32,988.75
|
|
|
HC PERSIMMON IGE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC PERSIMMON IGE
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC PET/CT - TUMOR LIMITED AREA
|
Facility
|
IP
|
$6,743.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
909301483
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,220.48 |
| Max. Negotiated Rate |
$5,057.25 |
| Rate for Payer: Adventist Health Commercial |
$1,348.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,632.44
|
| Rate for Payer: Cash Price |
$3,034.35
|
| Rate for Payer: Cash Price |
$3,034.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,565.01
|
| Rate for Payer: Heritage Provider Network Senior |
$4,565.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,220.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,685.75
|
| Rate for Payer: Multiplan Commercial |
$5,057.25
|
|
|
HC PET/CT - TUMOR LIMITED AREA
|
Facility
|
OP
|
$6,743.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
909301483
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$7,123.70 |
| Rate for Payer: Adventist Health Commercial |
$1,348.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,648.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,632.44
|
| 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: Blue Shield of California Commercial |
$7,123.70
|
| Rate for Payer: Blue Shield of California EPN |
$4,051.03
|
| Rate for Payer: Cash Price |
$3,034.35
|
| Rate for Payer: Cash Price |
$3,034.35
|
| Rate for Payer: Cash Price |
$3,034.35
|
| Rate for Payer: Cash Price |
$3,034.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,100.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: Dignity Health Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,169.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,954.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,465.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.00
|
| Rate for Payer: Humana Medicare |
$1,954.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,318.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,713.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,220.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,306.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,685.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,462.90
|
| Rate for Payer: Multiplan Commercial |
$5,057.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,659.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,659.12
|
| 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 SKULL BASE-THIGH
|
Facility
|
OP
|
$7,760.00
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
909301484
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$7,600.79 |
| Rate for Payer: Adventist Health Commercial |
$1,552.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,648.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,331.12
|
| 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: Blue Shield of California Commercial |
$7,600.79
|
| Rate for Payer: Blue Shield of California EPN |
$4,322.34
|
| Rate for Payer: Cash Price |
$3,492.00
|
| Rate for Payer: Cash Price |
$3,492.00
|
| Rate for Payer: Cash Price |
$3,492.00
|
| Rate for Payer: Cash Price |
$3,492.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,100.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: Dignity Health Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,169.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,954.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,465.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.00
|
| Rate for Payer: Humana Medicare |
$1,954.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,318.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,713.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,404.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,306.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,940.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,462.90
|
| Rate for Payer: Multiplan Commercial |
$5,820.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,659.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,659.12
|
| 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 SKULL BASE-THIGH
|
Facility
|
IP
|
$7,760.00
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
909301484
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,404.56 |
| Max. Negotiated Rate |
$5,820.00 |
| Rate for Payer: Adventist Health Commercial |
$1,552.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,331.12
|
| Rate for Payer: Cash Price |
$3,492.00
|
| Rate for Payer: Cash Price |
$3,492.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,253.52
|
| Rate for Payer: Heritage Provider Network Senior |
$5,253.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,404.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,940.00
|
| Rate for Payer: Multiplan Commercial |
$5,820.00
|
|
|
HC PET/CT - TUMOR WHOLE BODY
|
Facility
|
OP
|
$7,946.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301485
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$8,074.57 |
| Rate for Payer: Adventist Health Commercial |
$1,589.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,648.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,458.90
|
| 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: Blue Shield of California Commercial |
$8,074.57
|
| Rate for Payer: Blue Shield of California EPN |
$4,591.76
|
| Rate for Payer: Cash Price |
$3,575.70
|
| Rate for Payer: Cash Price |
$3,575.70
|
| Rate for Payer: Cash Price |
$3,575.70
|
| Rate for Payer: Cash Price |
$3,575.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,100.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: Dignity Health Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,169.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,954.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,465.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.00
|
| Rate for Payer: Humana Medicare |
$1,954.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,318.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,713.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,438.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,306.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,986.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,462.90
|
| Rate for Payer: Multiplan Commercial |
$5,959.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,659.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,659.12
|
| 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
|
$7,946.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301485
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,438.23 |
| Max. Negotiated Rate |
$5,959.50 |
| Rate for Payer: Adventist Health Commercial |
$1,589.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,458.90
|
| Rate for Payer: Cash Price |
$3,575.70
|
| Rate for Payer: Cash Price |
$3,575.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,379.44
|
| Rate for Payer: Heritage Provider Network Senior |
$5,379.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,438.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,986.50
|
| Rate for Payer: Multiplan Commercial |
$5,959.50
|
|
|
HC PET METABOLIC BRAIN
|
Facility
|
IP
|
$7,139.00
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
909301636
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,292.16 |
| Max. Negotiated Rate |
$5,354.25 |
| Rate for Payer: Adventist Health Commercial |
$1,427.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,904.49
|
| Rate for Payer: Cash Price |
$3,212.55
|
| Rate for Payer: Cash Price |
$3,212.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,833.10
|
| Rate for Payer: Heritage Provider Network Senior |
$4,833.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,292.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,784.75
|
| Rate for Payer: Multiplan Commercial |
$5,354.25
|
|
|
HC PET METABOLIC BRAIN
|
Facility
|
OP
|
$7,139.00
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
909301636
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$7,600.79 |
| Rate for Payer: Adventist Health Commercial |
$1,427.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,648.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,904.49
|
| 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: Blue Shield of California Commercial |
$7,600.79
|
| Rate for Payer: Blue Shield of California EPN |
$4,322.34
|
| Rate for Payer: Cash Price |
$3,212.55
|
| Rate for Payer: Cash Price |
$3,212.55
|
| Rate for Payer: Cash Price |
$3,212.55
|
| Rate for Payer: Cash Price |
$3,212.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,100.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: Dignity Health Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,169.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,954.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,465.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.00
|
| Rate for Payer: Humana Medicare |
$1,954.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,713.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,292.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,306.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,784.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,462.90
|
| Rate for Payer: Multiplan Commercial |
$5,354.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,659.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,659.12
|
| 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
|
|
