|
HC PERITONEOGRAM
|
Facility
|
IP
|
$1,379.00
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
909001474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.96 |
| Max. Negotiated Rate |
$1,172.15 |
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.60
|
| Rate for Payer: Galaxy Health WC |
$1,172.15
|
| Rate for Payer: Global Benefits Group Commercial |
$827.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.96
|
| Rate for Payer: Multiplan Commercial |
$1,103.20
|
| Rate for Payer: Networks By Design Commercial |
$896.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,172.15
|
|
|
HC PER ORAL ENDO MYOTOMY POEM
|
Facility
|
OP
|
$2,423.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906763499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$581.52 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,443.62
|
| Rate for Payer: Blue Distinction Transplant |
$1,453.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,090.35
|
| Rate for Payer: Cash Price |
$1,090.35
|
| Rate for Payer: Cigna of CA PPO |
$1,793.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,059.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,453.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,817.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,616.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,938.40
|
| Rate for Payer: Networks By Design Commercial |
$1,574.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,059.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,453.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC PER ORAL ENDO MYOTOMY POEM
|
Facility
|
IP
|
$2,423.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906763499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$581.52 |
| Max. Negotiated Rate |
$2,059.55 |
| Rate for Payer: Cash Price |
$1,090.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$969.20
|
| Rate for Payer: Galaxy Health WC |
$2,059.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,453.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,616.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.52
|
| Rate for Payer: Multiplan Commercial |
$1,938.40
|
| Rate for Payer: Networks By Design Commercial |
$1,574.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,059.55
|
|
|
HC PEROXIDASE STAIN
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$259.20 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
|
|
HC PEROXIDASE STAIN
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.42 |
| Max. Negotiated Rate |
$1,761.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$762.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.42
|
| Rate for Payer: Blue Distinction Transplant |
$235.20
|
| Rate for Payer: Blue Shield of California Commercial |
$253.23
|
| Rate for Payer: Blue Shield of California EPN |
$200.70
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna of CA HMO |
$250.88
|
| Rate for Payer: Cigna of CA PPO |
$290.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Media |
$1,074.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$333.20
|
| Rate for Payer: Global Benefits Group Commercial |
$235.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$294.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,761.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,761.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,740.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,740.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,074.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$261.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,353.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$313.60
|
| Rate for Payer: Networks By Design Commercial |
$254.80
|
| Rate for Payer: Prime Health Services Commercial |
$333.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC PERQ AV FIST UE SEP ACCESS PRPHL ARTERY AND VEIN
|
Facility
|
OP
|
$50,076.00
|
|
|
Service Code
|
CPT 36837
|
| Hospital Charge Code |
906816837
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,340.48 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| 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 |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$30,045.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$22,534.20
|
| Rate for Payer: Cash Price |
$22,534.20
|
| Rate for Payer: Cash Price |
$22,534.20
|
| Rate for Payer: Cigna of CA PPO |
$37,056.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$42,564.60
|
| Rate for Payer: Global Benefits Group Commercial |
$30,045.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37,557.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,400.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,018.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$40,060.80
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$32,549.40
|
| Rate for Payer: Prime Health Services Commercial |
$42,564.60
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,045.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| 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 AV FIST UE SEP ACCESS PRPHL ARTERY AND VEIN
|
Facility
|
IP
|
$50,076.00
|
|
|
Service Code
|
CPT 36837
|
| Hospital Charge Code |
906816837
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,018.24 |
| Max. Negotiated Rate |
$42,564.60 |
| Rate for Payer: Cash Price |
$22,534.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,030.40
|
| Rate for Payer: Galaxy Health WC |
$42,564.60
|
| Rate for Payer: Global Benefits Group Commercial |
$30,045.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,400.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,078.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,018.24
|
| Rate for Payer: Multiplan Commercial |
$40,060.80
|
| Rate for Payer: Networks By Design Commercial |
$32,549.40
|
| Rate for Payer: Prime Health Services Commercial |
$42,564.60
|
|
|
HC PERQ PRCRD DRG INS CATH CT GDN
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 33019
|
| Hospital Charge Code |
900503019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.56 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,057.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$904.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$904.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$986.40
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cigna of CA PPO |
$1,216.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Dignity Health Media |
$1,397.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,397.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,233.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.56
|
| Rate for Payer: Multiplan Commercial |
$1,315.20
|
| Rate for Payer: Networks By Design Commercial |
$1,068.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,397.40
|
|
|
HC PERQ PRCRD DRG INS CATH CT GDN
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
CPT 33019
|
| Hospital Charge Code |
900503019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.56 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.56
|
| Rate for Payer: Multiplan Commercial |
$1,315.20
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
|
|
HC PERQ STEN/CHEST VERT ART
|
Facility
|
OP
|
$34,342.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,257.00 |
| Max. Negotiated Rate |
$29,190.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,097.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,190.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,888.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,888.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,539.00
|
| Rate for Payer: Blue Distinction Transplant |
$20,605.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$15,453.90
|
| Rate for Payer: Cash Price |
$15,453.90
|
| Rate for Payer: Cash Price |
$15,453.90
|
| Rate for Payer: Cigna of CA PPO |
$25,413.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,190.70
|
| Rate for Payer: Dignity Health Media |
$29,190.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,190.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,736.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,736.80
|
| Rate for Payer: Galaxy Health WC |
$29,190.70
|
| Rate for Payer: Global Benefits Group Commercial |
$20,605.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25,756.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,906.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,084.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,242.08
|
| Rate for Payer: Multiplan Commercial |
$27,473.60
|
| Rate for Payer: Networks By Design Commercial |
$22,322.30
|
| Rate for Payer: Prime Health Services Commercial |
$29,190.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,605.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,190.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,190.70
|
| Rate for Payer: Vantage Medical Group Senior |
$29,190.70
|
|
|
HC PERQ STEN/CHEST VERT ART
|
Facility
|
IP
|
$34,342.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,242.08 |
| Max. Negotiated Rate |
$29,190.70 |
| Rate for Payer: Cash Price |
$15,453.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,736.80
|
| Rate for Payer: Galaxy Health WC |
$29,190.70
|
| Rate for Payer: Global Benefits Group Commercial |
$20,605.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,906.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,084.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,242.08
|
| Rate for Payer: Multiplan Commercial |
$27,473.60
|
| Rate for Payer: Networks By Design Commercial |
$22,322.30
|
| Rate for Payer: Prime Health Services Commercial |
$29,190.70
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
OP
|
$48,321.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,073.99 |
| Max. Negotiated Rate |
$51,156.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15,192.00
|
| 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 |
$8,628.00
|
| Rate for Payer: Blue Distinction Transplant |
$28,992.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Cigna of CA PPO |
$35,757.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$41,072.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28,992.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36,240.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,230.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,073.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,597.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$38,656.80
|
| Rate for Payer: Networks By Design Commercial |
$31,408.65
|
| Rate for Payer: Prime Health Services Commercial |
$41,072.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,992.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,992.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$41,597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$51,156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,783.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,722.00
|
| 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 CLOSURE PDA
|
Facility
|
IP
|
$48,321.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,597.04 |
| Max. Negotiated Rate |
$41,072.85 |
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,328.40
|
| Rate for Payer: Galaxy Health WC |
$41,072.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28,992.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,230.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,410.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,597.04
|
| Rate for Payer: Multiplan Commercial |
$38,656.80
|
| Rate for Payer: Networks By Design Commercial |
$31,408.65
|
| Rate for Payer: Prime Health Services Commercial |
$41,072.85
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
IP
|
$49,717.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,932.08 |
| Max. Negotiated Rate |
$42,259.45 |
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,886.80
|
| Rate for Payer: Galaxy Health WC |
$42,259.45
|
| Rate for Payer: Global Benefits Group Commercial |
$29,830.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,161.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,942.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,932.08
|
| Rate for Payer: Multiplan Commercial |
$39,773.60
|
| Rate for Payer: Networks By Design Commercial |
$32,316.05
|
| Rate for Payer: Prime Health Services Commercial |
$42,259.45
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
OP
|
$49,717.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,586.73 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,987.92
|
| 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 |
$8,628.00
|
| Rate for Payer: Blue Distinction Transplant |
$29,830.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| 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 PPO |
$36,790.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$42,259.45
|
| Rate for Payer: Global Benefits Group Commercial |
$29,830.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37,287.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,161.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,586.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,932.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$39,773.60
|
| Rate for Payer: Networks By Design Commercial |
$32,316.05
|
| Rate for Payer: Prime Health Services Commercial |
$42,259.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,830.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,830.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| 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 |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,911.46 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,064.29
|
| 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 |
$8,628.00
|
| Rate for Payer: Blue Distinction Transplant |
$23,373.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| 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 PPO |
$28,827.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$33,112.60
|
| Rate for Payer: Global Benefits Group Commercial |
$23,373.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29,217.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,983.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,349.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$31,164.80
|
| Rate for Payer: Networks By Design Commercial |
$25,321.40
|
| Rate for Payer: Prime Health Services Commercial |
$33,112.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,373.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,373.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| 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
|
$38,956.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,349.44 |
| Max. Negotiated Rate |
$33,112.60 |
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,582.40
|
| Rate for Payer: Galaxy Health WC |
$33,112.60
|
| Rate for Payer: Global Benefits Group Commercial |
$23,373.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,983.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,842.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,349.44
|
| Rate for Payer: Multiplan Commercial |
$31,164.80
|
| Rate for Payer: Networks By Design Commercial |
$25,321.40
|
| Rate for Payer: Prime Health Services Commercial |
$33,112.60
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
OP
|
$21,933.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$698.02 |
| Max. Negotiated Rate |
$18,643.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14,111.69
|
| 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 |
$12,063.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: Blue Distinction Transplant |
$13,159.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| 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 PPO |
$16,230.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,643.05
|
| Rate for Payer: Dignity Health Media |
$18,643.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,643.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,773.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,773.20
|
| Rate for Payer: Galaxy Health WC |
$18,643.05
|
| Rate for Payer: Global Benefits Group Commercial |
$13,159.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16,449.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,629.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$698.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,263.92
|
| Rate for Payer: Multiplan Commercial |
$17,546.40
|
| Rate for Payer: Networks By Design Commercial |
$14,256.45
|
| Rate for Payer: Prime Health Services Commercial |
$18,643.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,159.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,159.80
|
| 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 Commercial/Exchange |
$18,643.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,643.05
|
| Rate for Payer: Vantage Medical Group Senior |
$18,643.05
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
IP
|
$21,933.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,263.92 |
| Max. Negotiated Rate |
$18,643.05 |
| Rate for Payer: Cash Price |
$9,869.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,773.20
|
| Rate for Payer: Galaxy Health WC |
$18,643.05
|
| Rate for Payer: Global Benefits Group Commercial |
$13,159.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,629.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,356.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,263.92
|
| Rate for Payer: Multiplan Commercial |
$17,546.40
|
| Rate for Payer: Networks By Design Commercial |
$14,256.45
|
| Rate for Payer: Prime Health Services Commercial |
$18,643.05
|
|
|
HC PET/CT - TUMOR LIMITED AREA
|
Facility
|
OP
|
$12,987.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
909301483
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,954.68 |
| Max. Negotiated Rate |
$11,038.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,428.30
|
| 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 HMO/PPO |
$7,737.65
|
| Rate for Payer: Blue Distinction Transplant |
$7,792.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,675.32
|
| Rate for Payer: Blue Shield of California EPN |
$6,090.90
|
| Rate for Payer: Cash Price |
$5,844.15
|
| Rate for Payer: Cash Price |
$5,844.15
|
| Rate for Payer: Cigna of CA HMO |
$8,311.68
|
| Rate for Payer: Cigna of CA PPO |
$9,610.38
|
| 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 |
$11,038.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,792.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,740.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,205.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,662.33
|
| 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 |
$3,116.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$10,389.60
|
| Rate for Payer: Networks By Design Commercial |
$8,441.55
|
| Rate for Payer: Prime Health Services Commercial |
$11,038.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,792.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,792.20
|
| 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/CT - TUMOR LIMITED AREA
|
Facility
|
IP
|
$12,987.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
909301483
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,116.88 |
| Max. Negotiated Rate |
$11,038.95 |
| Rate for Payer: Cash Price |
$5,844.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,194.80
|
| Rate for Payer: Galaxy Health WC |
$11,038.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,792.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,662.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,948.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,116.88
|
| Rate for Payer: Multiplan Commercial |
$10,389.60
|
| Rate for Payer: Networks By Design Commercial |
$8,441.55
|
| Rate for Payer: Prime Health Services Commercial |
$11,038.95
|
|
|
HC PET/CT -TUMOR SKULL BASE-THIGH
|
Facility
|
OP
|
$13,974.00
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
909301484
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,954.68 |
| Max. Negotiated Rate |
$11,877.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,428.30
|
| 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 HMO/PPO |
$8,325.71
|
| Rate for Payer: Blue Distinction Transplant |
$8,384.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,258.63
|
| Rate for Payer: Blue Shield of California EPN |
$6,553.81
|
| Rate for Payer: Cash Price |
$6,288.30
|
| Rate for Payer: Cash Price |
$6,288.30
|
| Rate for Payer: Cigna of CA HMO |
$8,943.36
|
| Rate for Payer: Cigna of CA PPO |
$10,340.76
|
| 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 |
$11,877.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,384.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,205.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,320.66
|
| 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 |
$3,353.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$11,179.20
|
| Rate for Payer: Networks By Design Commercial |
$9,083.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,877.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,384.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,384.40
|
| 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 SKULL BASE-THIGH
|
Facility
|
IP
|
$13,974.00
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
909301484
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,353.76 |
| Max. Negotiated Rate |
$11,877.90 |
| Rate for Payer: Cash Price |
$6,288.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,589.60
|
| Rate for Payer: Galaxy Health WC |
$11,877.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,384.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,320.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,324.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,353.76
|
| Rate for Payer: Multiplan Commercial |
$11,179.20
|
| Rate for Payer: Networks By Design Commercial |
$9,083.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,877.90
|
|
|
HC PET/CT - TUMOR WHOLE BODY
|
Facility
|
IP
|
$13,736.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301485
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,296.64 |
| Max. Negotiated Rate |
$11,675.60 |
| Rate for Payer: Cash Price |
$6,181.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,494.40
|
| Rate for Payer: Galaxy Health WC |
$11,675.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,241.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,161.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,233.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,296.64
|
| Rate for Payer: Multiplan Commercial |
$10,988.80
|
| Rate for Payer: Networks By Design Commercial |
$8,928.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,675.60
|
|
|
HC PET/CT - TUMOR WHOLE BODY
|
Facility
|
OP
|
$13,736.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
909301485
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,954.68 |
| Max. Negotiated Rate |
$11,675.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,428.30
|
| 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 HMO/PPO |
$8,183.91
|
| Rate for Payer: Blue Distinction Transplant |
$8,241.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,117.98
|
| Rate for Payer: Blue Shield of California EPN |
$6,442.18
|
| Rate for Payer: Cash Price |
$6,181.20
|
| Rate for Payer: Cash Price |
$6,181.20
|
| Rate for Payer: Cigna of CA HMO |
$8,791.04
|
| Rate for Payer: Cigna of CA PPO |
$10,164.64
|
| 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 |
$11,675.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,241.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,302.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,205.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,166.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,161.91
|
| 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 |
$3,296.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$10,988.80
|
| Rate for Payer: Networks By Design Commercial |
$8,928.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,675.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,241.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,241.60
|
| 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
|
|
