|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
OP
|
$17,783.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$15,115.55 |
| Rate for Payer: Adventist Health Commercial |
$3,556.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,216.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,115.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,780.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,337.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$9,780.65
|
| Rate for Payer: Cash Price |
$9,780.65
|
| Rate for Payer: Cash Price |
$9,780.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,115.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,115.55
|
| Rate for Payer: Dignity Health Senior |
$15,115.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,558.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,007.68
|
| Rate for Payer: Heritage Provider Network Senior |
$11,007.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$595.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,482.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,218.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,445.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,448.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,448.10
|
| Rate for Payer: Multiplan Commercial |
$13,337.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,115.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,115.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15,115.55
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
OP
|
$33,347.00
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
909022513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$25,010.25 |
| Rate for Payer: Adventist Health Commercial |
$6,669.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,909.39
|
| 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 HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$18,340.85
|
| Rate for Payer: Cash Price |
$18,340.85
|
| Rate for Payer: Cash Price |
$18,340.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,675.55
|
| 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 Senior |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,076.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,641.79
|
| Rate for Payer: Heritage Provider Network Senior |
$11,164.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$756.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,035.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,438.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,336.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,436.79
|
| Rate for Payer: Multiplan Commercial |
$25,010.25
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,984.50
|
| Rate for Payer: TriValley Medical Group Senior |
$9,984.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| 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 22514
|
| Hospital Charge Code |
909022514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$25,010.25 |
| Rate for Payer: Adventist Health Commercial |
$6,669.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,909.39
|
| 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 HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$18,340.85
|
| Rate for Payer: Cash Price |
$18,340.85
|
| Rate for Payer: Cash Price |
$18,340.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,675.55
|
| 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 Senior |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,076.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,641.79
|
| Rate for Payer: Heritage Provider Network Senior |
$11,164.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$141.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,035.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,438.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,336.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,436.79
|
| Rate for Payer: Multiplan Commercial |
$25,010.25
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,984.50
|
| Rate for Payer: TriValley Medical Group Senior |
$9,984.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| 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 |
$3,928.00 |
| Max. Negotiated Rate |
$25,010.25 |
| Rate for Payer: Adventist Health Commercial |
$6,669.40
|
| Rate for Payer: Cash Price |
$18,340.85
|
| Rate for Payer: Cash Price |
$18,340.85
|
| 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 |
$6,035.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,336.75
|
| Rate for Payer: Multiplan Commercial |
$25,010.25
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
IP
|
$33,347.00
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
909022513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$25,010.25 |
| Rate for Payer: Adventist Health Commercial |
$6,669.40
|
| Rate for Payer: Cash Price |
$18,340.85
|
| Rate for Payer: Cash Price |
$18,340.85
|
| 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 |
$6,035.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,336.75
|
| Rate for Payer: Multiplan Commercial |
$25,010.25
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
IP
|
$33,347.00
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
909022514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,928.00 |
| Max. Negotiated Rate |
$25,010.25 |
| Rate for Payer: Adventist Health Commercial |
$6,669.40
|
| Rate for Payer: Cash Price |
$18,340.85
|
| Rate for Payer: Cash Price |
$18,340.85
|
| 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 |
$6,035.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,336.75
|
| Rate for Payer: Multiplan Commercial |
$25,010.25
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
OP
|
$33,347.00
|
|
|
Service Code
|
CPT 22515
|
| Hospital Charge Code |
909022515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$28,344.95 |
| Rate for Payer: Adventist Health Commercial |
$6,669.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,909.39
|
| 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 HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$18,340.85
|
| Rate for Payer: Cash Price |
$18,340.85
|
| Rate for Payer: Cash Price |
$18,340.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,675.55
|
| 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 Senior |
$28,344.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,641.79
|
| Rate for Payer: Heritage Provider Network Senior |
$20,641.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,906.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,035.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,336.75
|
| 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: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| 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 PERSIMMON IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.32 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.34
|
| 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 |
$144.32
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.90
|
| 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 |
$42.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.85
|
| Rate for Payer: Heritage Provider Network Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| 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 |
$49.50
|
| 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 PERSIMMON IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
|
|
HC PET/CT - TUMOR LIMITED AREA
|
Facility
|
OP
|
$7,367.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
909301483
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$7,337.71 |
| Rate for Payer: Adventist Health Commercial |
$1,473.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,937.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,061.13
|
| 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: Blue Shield of California Commercial |
$7,337.71
|
| Rate for Payer: Blue Shield of California EPN |
$5,900.74
|
| Rate for Payer: Cash Price |
$4,051.85
|
| Rate for Payer: Cash Price |
$4,051.85
|
| Rate for Payer: Cash Price |
$4,051.85
|
| Rate for Payer: Cash Price |
$4,051.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,100.00
|
| 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 Senior |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,169.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,853.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,465.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,445.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,514.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,333.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,131.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,841.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,335.13
|
| Rate for Payer: Multiplan Commercial |
$5,525.25
|
| 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 |
$2,779.92
|
| 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 LIMITED AREA
|
Facility
|
IP
|
$7,367.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
909301483
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,333.43 |
| Max. Negotiated Rate |
$5,525.25 |
| Rate for Payer: Adventist Health Commercial |
$1,473.40
|
| Rate for Payer: Cash Price |
$4,051.85
|
| Rate for Payer: Cash Price |
$4,051.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,987.46
|
| Rate for Payer: Heritage Provider Network Senior |
$4,987.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,333.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,841.75
|
| Rate for Payer: Multiplan Commercial |
$5,525.25
|
|
|
HC PET/CT -TUMOR SKULL BASE-THIGH
|
Facility
|
OP
|
$8,478.00
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
909301484
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$7,829.14 |
| Rate for Payer: Adventist Health Commercial |
$1,695.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,531.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,824.39
|
| 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: Blue Shield of California Commercial |
$7,829.14
|
| Rate for Payer: Blue Shield of California EPN |
$6,295.93
|
| Rate for Payer: Cash Price |
$4,662.90
|
| Rate for Payer: Cash Price |
$4,662.90
|
| Rate for Payer: Cash Price |
$4,662.90
|
| Rate for Payer: Cash Price |
$4,662.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,100.00
|
| 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 Senior |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,169.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,853.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,465.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,445.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,044.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,534.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,131.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,119.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,335.13
|
| Rate for Payer: Multiplan Commercial |
$6,358.50
|
| 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 |
$2,779.92
|
| 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
|
$8,478.00
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
909301484
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,534.52 |
| Max. Negotiated Rate |
$6,358.50 |
| Rate for Payer: Adventist Health Commercial |
$1,695.60
|
| Rate for Payer: Cash Price |
$4,662.90
|
| Rate for Payer: Cash Price |
$4,662.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,739.61
|
| Rate for Payer: Heritage Provider Network Senior |
$5,739.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,534.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,119.50
|
| Rate for Payer: Multiplan Commercial |
$6,358.50
|
|
|
HC PET/CT - TUMOR WHOLE BODY
|
Facility
|
IP
|
$8,681.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301485
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,571.26 |
| Max. Negotiated Rate |
$6,510.75 |
| Rate for Payer: Adventist Health Commercial |
$1,736.20
|
| Rate for Payer: Cash Price |
$4,774.55
|
| Rate for Payer: Cash Price |
$4,774.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,877.04
|
| Rate for Payer: Heritage Provider Network Senior |
$5,877.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,170.25
|
| Rate for Payer: Multiplan Commercial |
$6,510.75
|
|
|
HC PET/CT - TUMOR WHOLE BODY
|
Facility
|
OP
|
$8,681.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301485
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$8,317.15 |
| Rate for Payer: Adventist Health Commercial |
$1,736.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,639.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,963.85
|
| 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: Blue Shield of California Commercial |
$8,317.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,688.38
|
| Rate for Payer: Cash Price |
$4,774.55
|
| Rate for Payer: Cash Price |
$4,774.55
|
| Rate for Payer: Cash Price |
$4,774.55
|
| Rate for Payer: Cash Price |
$4,774.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,100.00
|
| 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 Senior |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,169.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,853.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,465.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,445.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,140.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,131.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,170.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,335.13
|
| Rate for Payer: Multiplan Commercial |
$6,510.75
|
| 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 |
$2,779.92
|
| 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 |
$1,276.59 |
| Max. Negotiated Rate |
$5,289.75 |
| Rate for Payer: Adventist Health Commercial |
$1,410.60
|
| Rate for Payer: Cash Price |
$3,879.15
|
| Rate for Payer: Cash Price |
$3,879.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,774.88
|
| Rate for Payer: Heritage Provider Network Senior |
$4,774.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,276.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,763.25
|
| Rate for Payer: Multiplan Commercial |
$5,289.75
|
|
|
HC PET METABOLIC BRAIN
|
Facility
|
OP
|
$7,053.00
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
909301636
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$7,829.14 |
| Rate for Payer: Adventist Health Commercial |
$1,410.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,769.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,845.41
|
| 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: Blue Shield of California Commercial |
$7,829.14
|
| Rate for Payer: Blue Shield of California EPN |
$6,295.93
|
| Rate for Payer: Cash Price |
$3,879.15
|
| Rate for Payer: Cash Price |
$3,879.15
|
| Rate for Payer: Cash Price |
$3,879.15
|
| Rate for Payer: Cash Price |
$3,879.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,100.00
|
| 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 Senior |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,169.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,853.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,465.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,364.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,276.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,131.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,763.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,335.13
|
| Rate for Payer: Multiplan Commercial |
$5,289.75
|
| 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 |
$2,779.92
|
| 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
|
$5,273.00
|
|
|
Service Code
|
CPT 78492
|
| Hospital Charge Code |
909301613
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$954.41 |
| Max. Negotiated Rate |
$3,954.75 |
| Rate for Payer: Adventist Health Commercial |
$1,054.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,818.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,622.55
|
| 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: Blue Shield of California Commercial |
$1,244.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,000.90
|
| Rate for Payer: Cash Price |
$2,900.15
|
| Rate for Payer: Cash Price |
$2,900.15
|
| Rate for Payer: Cash Price |
$2,900.15
|
| Rate for Payer: Cash Price |
$2,900.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,100.00
|
| 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 Senior |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,169.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,853.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,465.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,515.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$954.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,131.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,318.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,335.13
|
| Rate for Payer: Multiplan Commercial |
$3,954.75
|
| 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 |
$2,779.92
|
| 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
|
$5,273.00
|
|
|
Service Code
|
CPT 78492
|
| Hospital Charge Code |
909301613
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$954.41 |
| Max. Negotiated Rate |
$3,954.75 |
| Rate for Payer: Adventist Health Commercial |
$1,054.60
|
| Rate for Payer: Cash Price |
$2,900.15
|
| Rate for Payer: Cash Price |
$2,900.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,569.82
|
| Rate for Payer: Heritage Provider Network Senior |
$3,569.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$954.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,318.25
|
| Rate for Payer: Multiplan Commercial |
$3,954.75
|
|
|
HC PET MYOCARDIAL PERF SGL FLW
|
Facility
|
IP
|
$4,579.00
|
|
|
Service Code
|
CPT 78491
|
| Hospital Charge Code |
909301602
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$828.80 |
| Max. Negotiated Rate |
$3,434.25 |
| Rate for Payer: Adventist Health Commercial |
$915.80
|
| Rate for Payer: Cash Price |
$2,518.45
|
| Rate for Payer: Cash Price |
$2,518.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,099.98
|
| Rate for Payer: Heritage Provider Network Senior |
$3,099.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$828.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.75
|
| Rate for Payer: Multiplan Commercial |
$3,434.25
|
|
|
HC PET MYOCARDIAL PERF SGL FLW
|
Facility
|
OP
|
$4,579.00
|
|
|
Service Code
|
CPT 78491
|
| Hospital Charge Code |
909301602
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$803.88 |
| Max. Negotiated Rate |
$3,434.25 |
| Rate for Payer: Adventist Health Commercial |
$915.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,447.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,145.77
|
| 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: Blue Shield of California Commercial |
$999.65
|
| Rate for Payer: Blue Shield of California EPN |
$803.88
|
| Rate for Payer: Cash Price |
$2,518.45
|
| Rate for Payer: Cash Price |
$2,518.45
|
| Rate for Payer: Cash Price |
$2,518.45
|
| Rate for Payer: Cash Price |
$2,518.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,100.00
|
| 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 Senior |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,169.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,853.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,465.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,184.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$828.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,131.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,335.13
|
| Rate for Payer: Multiplan Commercial |
$3,434.25
|
| 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 |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC PET SCAN/GAMMA LYMPHOMA
|
Facility
|
OP
|
$10,537.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301467
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,853.28 |
| Max. Negotiated Rate |
$8,317.15 |
| Rate for Payer: Adventist Health Commercial |
$2,107.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,632.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,238.92
|
| 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: Blue Shield of California Commercial |
$8,317.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,688.38
|
| Rate for Payer: Cash Price |
$5,795.35
|
| Rate for Payer: Cash Price |
$5,795.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,849.05
|
| 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 Senior |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,849.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,853.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,522.40
|
| Rate for Payer: Heritage Provider Network Senior |
$6,522.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,445.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,026.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,907.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,131.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,634.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,335.13
|
| Rate for Payer: Multiplan Commercial |
$7,902.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,038.61
|
| Rate for Payer: TriValley Medical Group Senior |
$1,853.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,268.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,268.50
|
| 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 SCAN/GAMMA LYMPHOMA
|
Facility
|
IP
|
$10,537.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301467
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,907.20 |
| Max. Negotiated Rate |
$7,902.75 |
| Rate for Payer: Adventist Health Commercial |
$2,107.40
|
| Rate for Payer: Cash Price |
$5,795.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,133.55
|
| Rate for Payer: Heritage Provider Network Senior |
$7,133.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,907.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,634.25
|
| Rate for Payer: Multiplan Commercial |
$7,902.75
|
|
|
HC PET SCAN SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$7,581.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
909301481
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,372.16 |
| Max. Negotiated Rate |
$5,685.75 |
| Rate for Payer: Adventist Health Commercial |
$1,516.20
|
| Rate for Payer: Cash Price |
$4,169.55
|
| Rate for Payer: Cash Price |
$4,169.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,132.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5,132.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,372.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,895.25
|
| Rate for Payer: Multiplan Commercial |
$5,685.75
|
|
|
HC PET SCAN SKULL BASE TO MID THIGH
|
Facility
|
OP
|
$7,581.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
909301481
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$7,829.14 |
| Rate for Payer: Adventist Health Commercial |
$1,516.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,052.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,208.15
|
| 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: Blue Shield of California Commercial |
$7,829.14
|
| Rate for Payer: Blue Shield of California EPN |
$6,295.93
|
| Rate for Payer: Cash Price |
$4,169.55
|
| Rate for Payer: Cash Price |
$4,169.55
|
| Rate for Payer: Cash Price |
$4,169.55
|
| Rate for Payer: Cash Price |
$4,169.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,100.00
|
| 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 Senior |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,169.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,853.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,465.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,283.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,616.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,372.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,131.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,895.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,335.13
|
| Rate for Payer: Multiplan Commercial |
$5,685.75
|
| 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 |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
