|
HC PER ORAL ENDO MYOTOMY POEM
|
Facility
|
IP
|
$1,956.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906763499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$391.20 |
| Max. Negotiated Rate |
$1,662.60 |
| Rate for Payer: Adventist Health Commercial |
$391.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$782.40
|
| Rate for Payer: EPIC Health Plan Senior |
$782.40
|
| Rate for Payer: Galaxy Health WC |
$1,662.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,304.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$745.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,210.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.44
|
| Rate for Payer: Multiplan Commercial |
$1,564.80
|
| Rate for Payer: Networks By Design Commercial |
$1,271.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,662.60
|
|
|
HC PER ORAL ENDO MYOTOMY POEM
|
Facility
|
OP
|
$1,956.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906763499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$391.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$391.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,201.18
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cigna of CA HMO |
$1,251.84
|
| Rate for Payer: Cigna of CA PPO |
$1,447.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$1,662.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,304.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$1,564.80
|
| Rate for Payer: Networks By Design Commercial |
$1,271.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,662.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,173.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC PEROXIDASE STAIN
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC PEROXIDASE STAIN
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.82 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.82
|
| Rate for Payer: Blue Shield of California Commercial |
$256.23
|
| Rate for Payer: Blue Shield of California EPN |
$169.29
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cigna of CA HMO |
$245.12
|
| Rate for Payer: Cigna of CA PPO |
$283.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: Networks By Design Commercial |
$248.95
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| 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: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC PERQ AV FIST UE SEP ACCESS PRPHL ARTERY AND VEIN
|
Facility
|
IP
|
$48,949.00
|
|
|
Service Code
|
CPT 36837
|
| Hospital Charge Code |
906816837
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,789.80 |
| Max. Negotiated Rate |
$41,606.65 |
| Rate for Payer: Adventist Health Commercial |
$9,789.80
|
| Rate for Payer: Cash Price |
$22,027.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,579.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19,579.60
|
| Rate for Payer: Galaxy Health WC |
$41,606.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29,369.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,648.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,649.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,299.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,747.76
|
| Rate for Payer: Multiplan Commercial |
$39,159.20
|
| Rate for Payer: Networks By Design Commercial |
$31,816.85
|
| Rate for Payer: Prime Health Services Commercial |
$41,606.65
|
|
|
HC PERQ AV FIST UE SEP ACCESS PRPHL ARTERY AND VEIN
|
Facility
|
OP
|
$48,949.00
|
|
|
Service Code
|
CPT 36837
|
| Hospital Charge Code |
906816837
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,470.08 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$9,789.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$22,027.05
|
| Rate for Payer: Cash Price |
$22,027.05
|
| Rate for Payer: Cash Price |
$22,027.05
|
| Rate for Payer: Cigna of CA HMO |
$31,327.36
|
| Rate for Payer: Cigna of CA PPO |
$36,222.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$41,606.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29,369.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,648.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,747.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$39,159.20
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$31,816.85
|
| Rate for Payer: Prime Health Services Commercial |
$41,606.65
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,369.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ PRCRD DRG INS CATH CT GDN
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT 33019
|
| Hospital Charge Code |
900503019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$1,365.10 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$611.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.44
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
|
|
HC PERQ PRCRD DRG INS CATH CT GDN
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 33019
|
| Hospital Charge Code |
900503019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$883.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,204.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cigna of CA HMO |
$1,027.84
|
| Rate for Payer: Cigna of CA PPO |
$1,188.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,365.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,365.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,124.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,124.20
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$963.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,365.10
|
|
|
HC PERQ STEN/CHEST VERT ART
|
Facility
|
OP
|
$33,569.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,374.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$6,713.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28,533.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,462.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,176.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,411.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$15,106.05
|
| Rate for Payer: Cash Price |
$15,106.05
|
| Rate for Payer: Cigna of CA HMO |
$21,484.16
|
| Rate for Payer: Cigna of CA PPO |
$24,841.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28,533.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$28,533.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,533.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13,427.60
|
| Rate for Payer: Galaxy Health WC |
$28,533.65
|
| Rate for Payer: Global Benefits Group Commercial |
$20,141.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,390.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,789.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,779.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,056.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,498.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,498.30
|
| Rate for Payer: Multiplan Commercial |
$26,855.20
|
| Rate for Payer: Networks By Design Commercial |
$21,819.85
|
| Rate for Payer: Prime Health Services Commercial |
$28,533.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,141.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28,533.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28,533.65
|
| Rate for Payer: Vantage Medical Group Senior |
$28,533.65
|
|
|
HC PERQ STEN/CHEST VERT ART
|
Facility
|
IP
|
$33,569.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,713.80 |
| Max. Negotiated Rate |
$28,533.65 |
| Rate for Payer: Adventist Health Commercial |
$6,713.80
|
| Rate for Payer: Cash Price |
$15,106.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13,427.60
|
| Rate for Payer: Galaxy Health WC |
$28,533.65
|
| Rate for Payer: Global Benefits Group Commercial |
$20,141.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,390.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,789.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,779.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,056.56
|
| Rate for Payer: Multiplan Commercial |
$26,855.20
|
| Rate for Payer: Networks By Design Commercial |
$21,819.85
|
| Rate for Payer: Prime Health Services Commercial |
$28,533.65
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
IP
|
$47,234.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,446.80 |
| Max. Negotiated Rate |
$40,148.90 |
| Rate for Payer: Adventist Health Commercial |
$9,446.80
|
| Rate for Payer: Cash Price |
$21,255.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,893.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,893.60
|
| Rate for Payer: Galaxy Health WC |
$40,148.90
|
| Rate for Payer: Global Benefits Group Commercial |
$28,340.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,505.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,996.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,237.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,336.16
|
| Rate for Payer: Multiplan Commercial |
$37,787.20
|
| Rate for Payer: Networks By Design Commercial |
$30,702.10
|
| Rate for Payer: Prime Health Services Commercial |
$40,148.90
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
OP
|
$47,234.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$949.65 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$9,446.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,192.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$21,255.30
|
| Rate for Payer: Cash Price |
$21,255.30
|
| Rate for Payer: Cash Price |
$21,255.30
|
| Rate for Payer: Cigna of CA HMO |
$30,702.10
|
| Rate for Payer: Cigna of CA PPO |
$34,953.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$40,148.90
|
| Rate for Payer: Global Benefits Group Commercial |
$28,340.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$949.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,505.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,074.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,336.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$37,787.20
|
| Rate for Payer: Networks By Design Commercial |
$30,702.10
|
| Rate for Payer: Prime Health Services Commercial |
$40,148.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,340.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,340.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
IP
|
$48,598.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,719.60 |
| Max. Negotiated Rate |
$41,308.30 |
| Rate for Payer: Adventist Health Commercial |
$9,719.60
|
| Rate for Payer: Cash Price |
$21,869.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,439.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19,439.20
|
| Rate for Payer: Galaxy Health WC |
$41,308.30
|
| Rate for Payer: Global Benefits Group Commercial |
$29,158.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,515.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,082.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,663.52
|
| Rate for Payer: Multiplan Commercial |
$38,878.40
|
| Rate for Payer: Networks By Design Commercial |
$31,588.70
|
| Rate for Payer: Prime Health Services Commercial |
$41,308.30
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
IP
|
$47,231.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
906820092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,446.20 |
| Max. Negotiated Rate |
$40,146.35 |
| Rate for Payer: Adventist Health Commercial |
$9,446.20
|
| Rate for Payer: Cash Price |
$21,253.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18,892.40
|
| Rate for Payer: Galaxy Health WC |
$40,146.35
|
| Rate for Payer: Global Benefits Group Commercial |
$28,338.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,503.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,995.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,235.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,335.44
|
| Rate for Payer: Multiplan Commercial |
$37,784.80
|
| Rate for Payer: Networks By Design Commercial |
$30,700.15
|
| Rate for Payer: Prime Health Services Commercial |
$40,146.35
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
OP
|
$47,231.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
906820092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,403.00 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$9,446.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$21,253.95
|
| Rate for Payer: Cash Price |
$21,253.95
|
| Rate for Payer: Cash Price |
$21,253.95
|
| Rate for Payer: Cigna of CA HMO |
$30,700.15
|
| Rate for Payer: Cigna of CA PPO |
$34,950.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$40,146.35
|
| Rate for Payer: Global Benefits Group Commercial |
$28,338.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,403.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,503.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,586.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,335.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$37,784.80
|
| Rate for Payer: Networks By Design Commercial |
$30,700.15
|
| Rate for Payer: Prime Health Services Commercial |
$40,146.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,338.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,338.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
OP
|
$48,598.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,403.00 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$9,719.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$21,869.10
|
| Rate for Payer: Cash Price |
$21,869.10
|
| Rate for Payer: Cash Price |
$21,869.10
|
| Rate for Payer: Cigna of CA HMO |
$31,588.70
|
| Rate for Payer: Cigna of CA PPO |
$35,962.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$41,308.30
|
| Rate for Payer: Global Benefits Group Commercial |
$29,158.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,403.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,586.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,663.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$38,878.40
|
| Rate for Payer: Networks By Design Commercial |
$31,588.70
|
| Rate for Payer: Prime Health Services Commercial |
$41,308.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,158.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,158.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
OP
|
$38,079.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,690.13 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$7,615.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$17,135.55
|
| Rate for Payer: Cash Price |
$17,135.55
|
| Rate for Payer: Cash Price |
$17,135.55
|
| Rate for Payer: Cigna of CA HMO |
$24,751.35
|
| Rate for Payer: Cigna of CA PPO |
$28,178.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$32,367.15
|
| Rate for Payer: Global Benefits Group Commercial |
$22,847.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,690.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,398.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,138.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$30,463.20
|
| Rate for Payer: Networks By Design Commercial |
$24,751.35
|
| Rate for Payer: Prime Health Services Commercial |
$32,367.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,847.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,847.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
OP
|
$37,008.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906820301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,690.13 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$7,401.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$16,653.60
|
| Rate for Payer: Cash Price |
$16,653.60
|
| Rate for Payer: Cash Price |
$16,653.60
|
| Rate for Payer: Cigna of CA HMO |
$24,055.20
|
| Rate for Payer: Cigna of CA PPO |
$27,385.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$31,456.80
|
| Rate for Payer: Global Benefits Group Commercial |
$22,204.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,690.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,881.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$29,606.40
|
| Rate for Payer: Networks By Design Commercial |
$24,055.20
|
| Rate for Payer: Prime Health Services Commercial |
$31,456.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,204.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,204.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
IP
|
$38,079.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,615.80 |
| Max. Negotiated Rate |
$32,367.15 |
| Rate for Payer: Adventist Health Commercial |
$7,615.80
|
| Rate for Payer: Cash Price |
$17,135.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,231.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,231.60
|
| Rate for Payer: Galaxy Health WC |
$32,367.15
|
| Rate for Payer: Global Benefits Group Commercial |
$22,847.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,398.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,508.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,570.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,138.96
|
| Rate for Payer: Multiplan Commercial |
$30,463.20
|
| Rate for Payer: Networks By Design Commercial |
$24,751.35
|
| Rate for Payer: Prime Health Services Commercial |
$32,367.15
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
IP
|
$37,008.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906820301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,401.60 |
| Max. Negotiated Rate |
$31,456.80 |
| Rate for Payer: Adventist Health Commercial |
$7,401.60
|
| Rate for Payer: Cash Price |
$16,653.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,803.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,803.20
|
| Rate for Payer: Galaxy Health WC |
$31,456.80
|
| Rate for Payer: Global Benefits Group Commercial |
$22,204.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,100.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,907.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,881.92
|
| Rate for Payer: Multiplan Commercial |
$29,606.40
|
| Rate for Payer: Networks By Design Commercial |
$24,055.20
|
| Rate for Payer: Prime Health Services Commercial |
$31,456.80
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
OP
|
$20,836.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906820302
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$617.20 |
| Max. Negotiated Rate |
$17,710.60 |
| Rate for Payer: Adventist Health Commercial |
$4,167.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,710.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,459.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,627.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| 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 |
$13,543.40
|
| Rate for Payer: Cigna of CA PPO |
$15,418.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,710.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,710.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,710.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,334.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,334.40
|
| Rate for Payer: Galaxy Health WC |
$17,710.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,501.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$617.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,897.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$698.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,897.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,585.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,585.20
|
| Rate for Payer: Multiplan Commercial |
$16,668.80
|
| Rate for Payer: Networks By Design Commercial |
$13,543.40
|
| Rate for Payer: Prime Health Services Commercial |
$17,710.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,501.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,501.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,710.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,710.60
|
| Rate for Payer: Vantage Medical Group Senior |
$17,710.60
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
OP
|
$21,439.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$617.20 |
| Max. Negotiated Rate |
$18,223.15 |
| Rate for Payer: Adventist Health Commercial |
$4,287.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,223.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,791.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,079.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$9,647.55
|
| Rate for Payer: Cash Price |
$9,647.55
|
| Rate for Payer: Cash Price |
$9,647.55
|
| Rate for Payer: Cigna of CA HMO |
$13,935.35
|
| Rate for Payer: Cigna of CA PPO |
$15,864.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,223.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,223.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18,223.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,575.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,575.60
|
| Rate for Payer: Galaxy Health WC |
$18,223.15
|
| Rate for Payer: Global Benefits Group Commercial |
$12,863.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$617.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,299.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$698.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,270.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,145.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,007.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,007.30
|
| Rate for Payer: Multiplan Commercial |
$17,151.20
|
| Rate for Payer: Networks By Design Commercial |
$13,935.35
|
| Rate for Payer: Prime Health Services Commercial |
$18,223.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,863.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,863.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,223.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,223.15
|
| Rate for Payer: Vantage Medical Group Senior |
$18,223.15
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
IP
|
$20,836.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906820302
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,167.20 |
| Max. Negotiated Rate |
$17,710.60 |
| Rate for Payer: Adventist Health Commercial |
$4,167.20
|
| Rate for Payer: Cash Price |
$9,376.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,334.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,334.40
|
| Rate for Payer: Galaxy Health WC |
$17,710.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,501.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,897.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,938.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,897.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.64
|
| Rate for Payer: Multiplan Commercial |
$16,668.80
|
| Rate for Payer: Networks By Design Commercial |
$13,543.40
|
| Rate for Payer: Prime Health Services Commercial |
$17,710.60
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
IP
|
$21,439.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,287.80 |
| Max. Negotiated Rate |
$18,223.15 |
| Rate for Payer: Adventist Health Commercial |
$4,287.80
|
| Rate for Payer: Cash Price |
$9,647.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,575.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,575.60
|
| Rate for Payer: Galaxy Health WC |
$18,223.15
|
| Rate for Payer: Global Benefits Group Commercial |
$12,863.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,299.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,168.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,270.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,145.36
|
| Rate for Payer: Multiplan Commercial |
$17,151.20
|
| Rate for Payer: Networks By Design Commercial |
$13,935.35
|
| Rate for Payer: Prime Health Services Commercial |
$18,223.15
|
|
|
HC PERSIMMON IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$156.13 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.29
|
| 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 |
$156.13
|
| Rate for Payer: Blue Shield of California Commercial |
$44.15
|
| Rate for Payer: Blue Shield of California EPN |
$29.17
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
