|
HC PER ORAL ENDO MYOTOMY POEM
|
Facility
|
IP
|
$3,880.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906763499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$776.00 |
| Max. Negotiated Rate |
$3,492.00 |
| Rate for Payer: Adventist Health Commercial |
$776.00
|
| Rate for Payer: Cash Price |
$1,746.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,104.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,716.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.00
|
| Rate for Payer: Galaxy Health WC |
$3,298.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,492.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,463.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,289.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.00
|
| Rate for Payer: Multiplan Commercial |
$2,910.00
|
| Rate for Payer: Networks By Design Commercial |
$2,522.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.00
|
|
|
HC PER ORAL ENDO MYOTOMY POEM
|
Facility
|
OP
|
$3,880.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906763499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$776.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$776.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,878.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,257.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,746.00
|
| Rate for Payer: Cash Price |
$1,746.00
|
| Rate for Payer: Cash Price |
$1,746.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,104.00
|
| Rate for Payer: Cigna of CA HMO |
$2,483.20
|
| Rate for Payer: Cigna of CA PPO |
$2,871.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,716.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$3,298.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,492.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,463.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,910.00
|
| Rate for Payer: Networks By Design Commercial |
$2,522.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.00
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,328.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,940.00
|
| 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 |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
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 |
$950.40 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| 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: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC PEROXIDASE STAIN
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$1,709.80 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,036.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,036.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$762.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$762.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.52
|
| Rate for Payer: Blue Shield of California Commercial |
$241.29
|
| Rate for Payer: Blue Shield of California Commercial |
$665.28
|
| Rate for Payer: Blue Shield of California EPN |
$152.05
|
| Rate for Payer: Blue Shield of California EPN |
$419.23
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$245.12
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$283.42
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Networks By Design Commercial |
$248.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,036.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,098.41
|
| Rate for Payer: Prime Health Services Medicare |
$1,098.41
|
| Rate for Payer: Riverside University Health System MISP |
$1,139.86
|
| Rate for Payer: Riverside University Health System MISP |
$1,139.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| 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 All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
|
HC PERQ ABLTJ LIVER CRYOABLATION
|
Facility
|
IP
|
$24,886.00
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
909047383
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,977.20 |
| Max. Negotiated Rate |
$22,397.40 |
| Rate for Payer: Adventist Health Commercial |
$4,977.20
|
| Rate for Payer: Cash Price |
$11,198.70
|
| Rate for Payer: Central Health Plan Commercial |
$19,908.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,420.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,954.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,954.40
|
| Rate for Payer: Galaxy Health WC |
$21,153.10
|
| Rate for Payer: Global Benefits Group Commercial |
$14,931.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,397.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,802.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,682.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,977.20
|
| Rate for Payer: Multiplan Commercial |
$18,664.50
|
| Rate for Payer: Networks By Design Commercial |
$16,175.90
|
| Rate for Payer: Prime Health Services Commercial |
$21,153.10
|
|
|
HC PERQ ABLTJ LIVER CRYOABLATION
|
Facility
|
OP
|
$24,886.00
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
909047383
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$717.21 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,977.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,671.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,671.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,077.25
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$11,198.70
|
| Rate for Payer: Cash Price |
$11,198.70
|
| Rate for Payer: Cash Price |
$11,198.70
|
| Rate for Payer: Central Health Plan Commercial |
$19,908.80
|
| Rate for Payer: Cigna of CA HMO |
$15,927.04
|
| Rate for Payer: Cigna of CA PPO |
$18,415.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,038.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,671.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,420.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,558.37
|
| Rate for Payer: EPIC Health Plan Senior |
$15,038.91
|
| Rate for Payer: Galaxy Health WC |
$21,153.10
|
| Rate for Payer: Global Benefits Group Commercial |
$14,931.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,397.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,421.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$717.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,802.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$792.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,140.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,977.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,320.13
|
| Rate for Payer: Multiplan Commercial |
$18,664.50
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: Networks By Design Commercial |
$16,175.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Preferred Health Network WC |
$21,507.40
|
| Rate for Payer: Prime Health Services Commercial |
$21,153.10
|
| Rate for Payer: Prime Health Services Medicare |
$14,492.04
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Riverside University Health System MISP |
$15,038.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,931.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,443.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,671.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13,671.74
|
|
|
HC PERQ AV FIST UE SEP ACCESS PRPHL ARTERY AND VEIN
|
Facility
|
OP
|
$40,436.00
|
|
|
Service Code
|
CPT 36837
|
| Hospital Charge Code |
906816837
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,165.61 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$8,087.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$18,196.20
|
| Rate for Payer: Cash Price |
$18,196.20
|
| Rate for Payer: Cash Price |
$18,196.20
|
| Rate for Payer: Central Health Plan Commercial |
$32,348.80
|
| Rate for Payer: Cigna of CA HMO |
$25,879.04
|
| Rate for Payer: Cigna of CA PPO |
$29,922.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28,305.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$34,370.60
|
| Rate for Payer: Global Benefits Group Commercial |
$24,261.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,392.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,676.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,087.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$30,327.00
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$26,283.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$34,370.60
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24,261.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20,218.00
|
| 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 |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC PERQ AV FIST UE SEP ACCESS PRPHL ARTERY AND VEIN
|
Facility
|
IP
|
$40,436.00
|
|
|
Service Code
|
CPT 36837
|
| Hospital Charge Code |
906816837
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,087.20 |
| Max. Negotiated Rate |
$36,392.40 |
| Rate for Payer: Adventist Health Commercial |
$8,087.20
|
| Rate for Payer: Cash Price |
$18,196.20
|
| Rate for Payer: Central Health Plan Commercial |
$32,348.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28,305.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,174.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16,174.40
|
| Rate for Payer: Galaxy Health WC |
$34,370.60
|
| Rate for Payer: Global Benefits Group Commercial |
$24,261.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,392.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,676.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,857.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,087.20
|
| Rate for Payer: Multiplan Commercial |
$30,327.00
|
| Rate for Payer: Networks By Design Commercial |
$26,283.40
|
| Rate for Payer: Prime Health Services Commercial |
$34,370.60
|
|
|
HC PERQ CERVICOTHORACIC INJECT
|
Facility
|
OP
|
$13,725.00
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
909022510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$677.49 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,745.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,208.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,980.00
|
| Rate for Payer: Cigna of CA HMO |
$8,784.00
|
| Rate for Payer: Cigna of CA PPO |
$10,156.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,607.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$11,666.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,235.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,352.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$677.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,715.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$748.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,745.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$10,293.75
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$8,921.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$11,666.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,235.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,862.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC PERQ CERVICOTHORACIC INJECT
|
Facility
|
IP
|
$13,725.00
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
909022510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,745.00 |
| Max. Negotiated Rate |
$12,352.50 |
| Rate for Payer: Adventist Health Commercial |
$2,745.00
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,980.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,607.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,490.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,490.00
|
| Rate for Payer: Galaxy Health WC |
$11,666.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,235.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,352.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,715.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,097.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,745.00
|
| Rate for Payer: Multiplan Commercial |
$10,293.75
|
| Rate for Payer: Networks By Design Commercial |
$8,921.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,666.25
|
|
|
HC PERQ LUMBOSACRAL INJECT
|
Facility
|
IP
|
$13,725.00
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
909022511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,745.00 |
| Max. Negotiated Rate |
$12,352.50 |
| Rate for Payer: Adventist Health Commercial |
$2,745.00
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,980.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,607.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,490.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,490.00
|
| Rate for Payer: Galaxy Health WC |
$11,666.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,235.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,352.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,715.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,097.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,745.00
|
| Rate for Payer: Multiplan Commercial |
$10,293.75
|
| Rate for Payer: Networks By Design Commercial |
$8,921.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,666.25
|
|
|
HC PERQ LUMBOSACRAL INJECT
|
Facility
|
OP
|
$13,725.00
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
909022511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$636.52 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,745.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,208.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,980.00
|
| Rate for Payer: Cigna of CA HMO |
$8,784.00
|
| Rate for Payer: Cigna of CA PPO |
$10,156.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,607.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$11,666.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,235.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,352.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$636.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,715.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,745.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$10,293.75
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$8,921.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$11,666.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,235.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,862.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC PERQ PRCRD DRG INS CATH CT GDN
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 33019
|
| Hospital Charge Code |
900503019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$929.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$843.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$783.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
|
|
HC PERQ PRCRD DRG INS CATH CT GDN
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 33019
|
| Hospital Charge Code |
900503019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$730.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: Cigna of CA HMO |
$849.92
|
| Rate for Payer: Cigna of CA PPO |
$982.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,128.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,128.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$929.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$332.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$843.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$783.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
| Rate for Payer: Riverside University Health System MISP |
$531.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$664.00
|
| 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 |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,128.80
|
|
|
HC PERQ STEN/CHEST VERT ART
|
Facility
|
IP
|
$32,626.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,525.20 |
| Max. Negotiated Rate |
$29,363.40 |
| Rate for Payer: Adventist Health Commercial |
$6,525.20
|
| Rate for Payer: Cash Price |
$14,681.70
|
| Rate for Payer: Central Health Plan Commercial |
$26,100.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,838.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,050.40
|
| Rate for Payer: EPIC Health Plan Senior |
$13,050.40
|
| Rate for Payer: Galaxy Health WC |
$27,732.10
|
| Rate for Payer: Global Benefits Group Commercial |
$19,575.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$29,363.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,717.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,249.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,525.20
|
| Rate for Payer: Multiplan Commercial |
$24,469.50
|
| Rate for Payer: Networks By Design Commercial |
$21,206.90
|
| Rate for Payer: Prime Health Services Commercial |
$27,732.10
|
|
|
HC PERQ STEN/CHEST VERT ART
|
Facility
|
OP
|
$32,626.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,374.00 |
| Max. Negotiated Rate |
$29,363.40 |
| Rate for Payer: Adventist Health Commercial |
$6,525.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27,732.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,944.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,469.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$14,681.70
|
| Rate for Payer: Cash Price |
$14,681.70
|
| Rate for Payer: Central Health Plan Commercial |
$26,100.80
|
| Rate for Payer: Cigna of CA HMO |
$20,880.64
|
| Rate for Payer: Cigna of CA PPO |
$24,143.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27,732.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,732.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27,732.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,838.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,050.40
|
| Rate for Payer: EPIC Health Plan Senior |
$13,050.40
|
| Rate for Payer: Galaxy Health WC |
$27,732.10
|
| Rate for Payer: Global Benefits Group Commercial |
$19,575.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$29,363.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,717.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,843.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,249.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,525.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,838.20
|
| Rate for Payer: Multiplan Commercial |
$24,469.50
|
| Rate for Payer: Networks By Design Commercial |
$21,206.90
|
| Rate for Payer: Prime Health Services Commercial |
$27,732.10
|
| Rate for Payer: Riverside University Health System MISP |
$13,050.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,575.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,313.00
|
| 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 |
$27,732.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,732.10
|
| Rate for Payer: Vantage Medical Group Senior |
$27,732.10
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
IP
|
$39,019.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,803.80 |
| Max. Negotiated Rate |
$35,117.10 |
| Rate for Payer: Adventist Health Commercial |
$7,803.80
|
| Rate for Payer: Cash Price |
$17,558.55
|
| Rate for Payer: Central Health Plan Commercial |
$31,215.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27,313.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,607.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,607.60
|
| Rate for Payer: Galaxy Health WC |
$33,166.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23,411.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,117.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,777.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,021.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,803.80
|
| Rate for Payer: Multiplan Commercial |
$29,264.25
|
| Rate for Payer: Networks By Design Commercial |
$25,362.35
|
| Rate for Payer: Prime Health Services Commercial |
$33,166.15
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
OP
|
$39,019.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$972.26 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$7,803.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$17,558.55
|
| Rate for Payer: Cash Price |
$17,558.55
|
| Rate for Payer: Cash Price |
$17,558.55
|
| Rate for Payer: Central Health Plan Commercial |
$31,215.20
|
| Rate for Payer: Cigna of CA HMO |
$25,362.35
|
| Rate for Payer: Cigna of CA PPO |
$28,874.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27,313.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$33,166.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23,411.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,117.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$972.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,777.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,074.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,803.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$29,264.25
|
| Rate for Payer: Networks By Design Commercial |
$25,362.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Prime Health Services Commercial |
$33,166.15
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,411.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,411.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19,509.50
|
| 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 |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
IP
|
$40,146.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,029.20 |
| Max. Negotiated Rate |
$36,131.40 |
| Rate for Payer: Adventist Health Commercial |
$8,029.20
|
| Rate for Payer: Cash Price |
$18,065.70
|
| Rate for Payer: Central Health Plan Commercial |
$32,116.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28,102.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,058.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16,058.40
|
| Rate for Payer: Galaxy Health WC |
$34,124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$24,087.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,131.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,492.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,686.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,029.20
|
| Rate for Payer: Multiplan Commercial |
$30,109.50
|
| Rate for Payer: Networks By Design Commercial |
$26,094.90
|
| Rate for Payer: Prime Health Services Commercial |
$34,124.10
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
OP
|
$40,146.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,436.41 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$8,029.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$18,065.70
|
| Rate for Payer: Cash Price |
$18,065.70
|
| Rate for Payer: Cash Price |
$18,065.70
|
| Rate for Payer: Central Health Plan Commercial |
$32,116.80
|
| Rate for Payer: Cigna of CA HMO |
$26,094.90
|
| Rate for Payer: Cigna of CA PPO |
$29,708.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28,102.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$34,124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$24,087.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,131.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,436.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,492.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,586.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,029.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$30,109.50
|
| Rate for Payer: Networks By Design Commercial |
$26,094.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Prime Health Services Commercial |
$34,124.10
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24,087.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24,087.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20,073.00
|
| 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 |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
IP
|
$31,457.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,291.40 |
| Max. Negotiated Rate |
$28,311.30 |
| Rate for Payer: Adventist Health Commercial |
$6,291.40
|
| Rate for Payer: Cash Price |
$14,155.65
|
| Rate for Payer: Central Health Plan Commercial |
$25,165.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,019.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,582.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12,582.80
|
| Rate for Payer: Galaxy Health WC |
$26,738.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,874.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,311.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,975.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,559.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,291.40
|
| Rate for Payer: Multiplan Commercial |
$23,592.75
|
| Rate for Payer: Networks By Design Commercial |
$20,447.05
|
| Rate for Payer: Prime Health Services Commercial |
$26,738.45
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
OP
|
$31,457.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,730.37 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$6,291.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$14,155.65
|
| Rate for Payer: Cash Price |
$14,155.65
|
| Rate for Payer: Cash Price |
$14,155.65
|
| Rate for Payer: Central Health Plan Commercial |
$25,165.60
|
| Rate for Payer: Cigna of CA HMO |
$20,447.05
|
| Rate for Payer: Cigna of CA PPO |
$23,278.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,019.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$26,738.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,874.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,311.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,730.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,975.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,911.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,291.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$23,592.75
|
| Rate for Payer: Networks By Design Commercial |
$20,447.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Prime Health Services Commercial |
$26,738.45
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,874.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,874.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,728.50
|
| 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 |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
IP
|
$17,711.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,542.20 |
| Max. Negotiated Rate |
$15,939.90 |
| Rate for Payer: Adventist Health Commercial |
$3,542.20
|
| Rate for Payer: Cash Price |
$7,969.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,168.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,397.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,084.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,084.40
|
| Rate for Payer: Galaxy Health WC |
$15,054.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,626.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,939.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,246.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,449.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,542.20
|
| Rate for Payer: Multiplan Commercial |
$13,283.25
|
| Rate for Payer: Networks By Design Commercial |
$11,512.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,054.35
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
OP
|
$17,711.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$631.89 |
| Max. Negotiated Rate |
$15,939.90 |
| Rate for Payer: Adventist Health Commercial |
$3,542.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,054.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,741.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,283.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$7,969.95
|
| Rate for Payer: Cash Price |
$7,969.95
|
| Rate for Payer: Cash Price |
$7,969.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,168.80
|
| Rate for Payer: Cigna of CA HMO |
$11,512.15
|
| Rate for Payer: Cigna of CA PPO |
$13,106.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,054.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,054.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,054.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,397.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,084.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,084.40
|
| Rate for Payer: Galaxy Health WC |
$15,054.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,626.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,939.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$631.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,246.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$698.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,449.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,542.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,397.70
|
| Rate for Payer: Multiplan Commercial |
$13,283.25
|
| Rate for Payer: Networks By Design Commercial |
$11,512.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,054.35
|
| Rate for Payer: Riverside University Health System MISP |
$7,084.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,626.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,626.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,855.50
|
| 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 |
$15,054.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,054.35
|
| Rate for Payer: Vantage Medical Group Senior |
$15,054.35
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
OP
|
$33,347.00
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
909022513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$803.00 |
| Max. Negotiated Rate |
$30,012.30 |
| Rate for Payer: Adventist Health Commercial |
$6,669.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,332.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$15,006.15
|
| Rate for Payer: Cash Price |
$15,006.15
|
| Rate for Payer: Cash Price |
$15,006.15
|
| Rate for Payer: Central Health Plan Commercial |
$26,677.60
|
| Rate for Payer: Cigna of CA HMO |
$21,342.08
|
| Rate for Payer: Cigna of CA PPO |
$24,676.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,342.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Galaxy Health WC |
$28,344.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,008.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,012.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$803.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,175.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$887.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,065.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,669.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$25,010.25
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$21,675.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$28,344.95
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,008.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,673.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
