|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
OP
|
$48,321.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,073.99 |
| Max. Negotiated Rate |
$51,156.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Distinction Transplant |
$28,992.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Central Health Plan Commercial |
$38,656.80
|
| Rate for Payer: Cigna of CA PPO |
$35,757.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$41,072.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28,992.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,488.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36,240.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,149.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: InnovAge PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,230.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,073.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,664.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$36,240.75
|
| Rate for Payer: Networks By Design Commercial |
$31,408.65
|
| Rate for Payer: Prime Health Services Commercial |
$41,072.85
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Riverside University Health System MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,992.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,992.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$41,597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$51,156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,783.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,722.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
OP
|
$49,717.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
906820092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,586.73 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31,709.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Distinction Transplant |
$29,830.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Central Health Plan Commercial |
$39,773.60
|
| Rate for Payer: Cigna of CA PPO |
$36,790.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$42,259.45
|
| Rate for Payer: Global Benefits Group Commercial |
$29,830.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$44,745.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37,287.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,149.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: InnovAge PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,161.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,586.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,943.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$37,287.75
|
| Rate for Payer: Networks By Design Commercial |
$32,316.05
|
| Rate for Payer: Prime Health Services Commercial |
$42,259.45
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Riverside University Health System MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,830.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,830.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
IP
|
$49,717.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
906820092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,943.40 |
| Max. Negotiated Rate |
$44,745.30 |
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Central Health Plan Commercial |
$39,773.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,886.80
|
| Rate for Payer: Galaxy Health WC |
$42,259.45
|
| Rate for Payer: Global Benefits Group Commercial |
$29,830.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$44,745.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,161.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,942.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,943.40
|
| Rate for Payer: Multiplan Commercial |
$37,287.75
|
| Rate for Payer: Networks By Design Commercial |
$32,316.05
|
| Rate for Payer: Prime Health Services Commercial |
$42,259.45
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
IP
|
$49,717.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,943.40 |
| Max. Negotiated Rate |
$44,745.30 |
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Central Health Plan Commercial |
$39,773.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,886.80
|
| Rate for Payer: Galaxy Health WC |
$42,259.45
|
| Rate for Payer: Global Benefits Group Commercial |
$29,830.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$44,745.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,161.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,942.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,943.40
|
| Rate for Payer: Multiplan Commercial |
$37,287.75
|
| Rate for Payer: Networks By Design Commercial |
$32,316.05
|
| Rate for Payer: Prime Health Services Commercial |
$42,259.45
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
OP
|
$49,717.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,586.73 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31,709.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Distinction Transplant |
$29,830.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Central Health Plan Commercial |
$39,773.60
|
| Rate for Payer: Cigna of CA PPO |
$36,790.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$42,259.45
|
| Rate for Payer: Global Benefits Group Commercial |
$29,830.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$44,745.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37,287.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,149.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: InnovAge PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,161.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,586.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,943.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$37,287.75
|
| Rate for Payer: Networks By Design Commercial |
$32,316.05
|
| Rate for Payer: Prime Health Services Commercial |
$42,259.45
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Riverside University Health System MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,830.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,830.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
OP
|
$38,956.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906820301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,911.46 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24,846.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Distinction Transplant |
$23,373.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: Central Health Plan Commercial |
$31,164.80
|
| Rate for Payer: Cigna of CA PPO |
$28,827.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$33,112.60
|
| Rate for Payer: Global Benefits Group Commercial |
$23,373.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,060.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29,217.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,149.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: InnovAge PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,983.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,791.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$29,217.00
|
| Rate for Payer: Networks By Design Commercial |
$25,321.40
|
| Rate for Payer: Prime Health Services Commercial |
$33,112.60
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Riverside University Health System MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,373.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,373.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
IP
|
$38,956.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,791.20 |
| Max. Negotiated Rate |
$35,060.40 |
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: Central Health Plan Commercial |
$31,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,582.40
|
| Rate for Payer: Galaxy Health WC |
$33,112.60
|
| Rate for Payer: Global Benefits Group Commercial |
$23,373.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,060.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,983.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,842.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,791.20
|
| Rate for Payer: Multiplan Commercial |
$29,217.00
|
| Rate for Payer: Networks By Design Commercial |
$25,321.40
|
| Rate for Payer: Prime Health Services Commercial |
$33,112.60
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
IP
|
$38,956.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906820301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,791.20 |
| Max. Negotiated Rate |
$35,060.40 |
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: Central Health Plan Commercial |
$31,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,582.40
|
| Rate for Payer: Galaxy Health WC |
$33,112.60
|
| Rate for Payer: Global Benefits Group Commercial |
$23,373.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,060.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,983.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,842.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,791.20
|
| Rate for Payer: Multiplan Commercial |
$29,217.00
|
| Rate for Payer: Networks By Design Commercial |
$25,321.40
|
| Rate for Payer: Prime Health Services Commercial |
$33,112.60
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
OP
|
$38,956.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,911.46 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24,846.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Distinction Transplant |
$23,373.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: Central Health Plan Commercial |
$31,164.80
|
| Rate for Payer: Cigna of CA PPO |
$28,827.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$33,112.60
|
| Rate for Payer: Global Benefits Group Commercial |
$23,373.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,060.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29,217.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,149.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: InnovAge PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,983.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,791.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$29,217.00
|
| Rate for Payer: Networks By Design Commercial |
$25,321.40
|
| Rate for Payer: Prime Health Services Commercial |
$33,112.60
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Riverside University Health System MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,373.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,373.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
IP
|
$21,933.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906820302
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,386.60 |
| Max. Negotiated Rate |
$19,739.70 |
| Rate for Payer: Cash Price |
$9,869.85
|
| Rate for Payer: Central Health Plan Commercial |
$17,546.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,773.20
|
| Rate for Payer: Galaxy Health WC |
$18,643.05
|
| Rate for Payer: Global Benefits Group Commercial |
$13,159.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,739.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,629.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,356.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,386.60
|
| Rate for Payer: Multiplan Commercial |
$16,449.75
|
| Rate for Payer: Networks By Design Commercial |
$14,256.45
|
| Rate for Payer: Prime Health Services Commercial |
$18,643.05
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
OP
|
$21,933.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906820302
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$698.02 |
| Max. Negotiated Rate |
$19,739.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,988.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,643.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,063.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,063.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Distinction Transplant |
$13,159.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$9,869.85
|
| Rate for Payer: Cash Price |
$9,869.85
|
| Rate for Payer: Cash Price |
$9,869.85
|
| Rate for Payer: Central Health Plan Commercial |
$17,546.40
|
| Rate for Payer: Cigna of CA PPO |
$16,230.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,643.05
|
| Rate for Payer: Dignity Health Media |
$18,643.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,643.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,773.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,773.20
|
| Rate for Payer: Galaxy Health WC |
$18,643.05
|
| Rate for Payer: Global Benefits Group Commercial |
$13,159.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,739.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16,449.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,676.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,629.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$698.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,386.60
|
| Rate for Payer: Multiplan Commercial |
$16,449.75
|
| Rate for Payer: Networks By Design Commercial |
$14,256.45
|
| Rate for Payer: Prime Health Services Commercial |
$18,643.05
|
| Rate for Payer: Riverside University Health System MISP |
$8,773.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,159.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,159.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,643.05
|
| Rate for Payer: Vantage Medical Group Senior |
$18,643.05
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
IP
|
$21,933.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,386.60 |
| Max. Negotiated Rate |
$19,739.70 |
| Rate for Payer: Cash Price |
$9,869.85
|
| Rate for Payer: Central Health Plan Commercial |
$17,546.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,773.20
|
| Rate for Payer: Galaxy Health WC |
$18,643.05
|
| Rate for Payer: Global Benefits Group Commercial |
$13,159.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,739.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,629.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,356.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,386.60
|
| Rate for Payer: Multiplan Commercial |
$16,449.75
|
| Rate for Payer: Networks By Design Commercial |
$14,256.45
|
| Rate for Payer: Prime Health Services Commercial |
$18,643.05
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
OP
|
$21,933.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$698.02 |
| Max. Negotiated Rate |
$19,739.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,988.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,643.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,063.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,063.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Distinction Transplant |
$13,159.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$9,869.85
|
| Rate for Payer: Cash Price |
$9,869.85
|
| Rate for Payer: Cash Price |
$9,869.85
|
| Rate for Payer: Central Health Plan Commercial |
$17,546.40
|
| Rate for Payer: Cigna of CA PPO |
$16,230.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,643.05
|
| Rate for Payer: Dignity Health Media |
$18,643.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,643.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,773.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,773.20
|
| Rate for Payer: Galaxy Health WC |
$18,643.05
|
| Rate for Payer: Global Benefits Group Commercial |
$13,159.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,739.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16,449.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,676.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,629.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$698.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,386.60
|
| Rate for Payer: Multiplan Commercial |
$16,449.75
|
| Rate for Payer: Networks By Design Commercial |
$14,256.45
|
| Rate for Payer: Prime Health Services Commercial |
$18,643.05
|
| Rate for Payer: Riverside University Health System MISP |
$8,773.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,159.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,159.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,643.05
|
| Rate for Payer: Vantage Medical Group Senior |
$18,643.05
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
IP
|
$25,215.00
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
909022513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,043.00 |
| Max. Negotiated Rate |
$22,693.50 |
| Rate for Payer: Cash Price |
$11,346.75
|
| Rate for Payer: Central Health Plan Commercial |
$20,172.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,086.00
|
| Rate for Payer: Galaxy Health WC |
$21,432.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,693.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,818.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,606.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,043.00
|
| Rate for Payer: Multiplan Commercial |
$18,911.25
|
| Rate for Payer: Networks By Design Commercial |
$16,389.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,432.75
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
IP
|
$25,215.00
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
909022514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,043.00 |
| Max. Negotiated Rate |
$22,693.50 |
| Rate for Payer: Cash Price |
$11,346.75
|
| Rate for Payer: Central Health Plan Commercial |
$20,172.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,086.00
|
| Rate for Payer: Galaxy Health WC |
$21,432.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,693.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,818.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,606.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,043.00
|
| Rate for Payer: Multiplan Commercial |
$18,911.25
|
| Rate for Payer: Networks By Design Commercial |
$16,389.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,432.75
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
OP
|
$25,215.00
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
909022513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$887.03 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,938.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Distinction Transplant |
$15,129.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Cash Price |
$11,346.75
|
| Rate for Payer: Cash Price |
$11,346.75
|
| Rate for Payer: Central Health Plan Commercial |
$20,172.00
|
| Rate for Payer: Cigna of CA PPO |
$18,659.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$21,432.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,693.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,911.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,748.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: InnovAge PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,818.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$887.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,043.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$18,911.25
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$16,389.75
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Commercial |
$21,432.75
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health System MISP |
$9,832.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
IP
|
$25,215.00
|
|
|
Service Code
|
CPT 22515
|
| Hospital Charge Code |
909022515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,043.00 |
| Max. Negotiated Rate |
$22,693.50 |
| Rate for Payer: Cash Price |
$11,346.75
|
| Rate for Payer: Central Health Plan Commercial |
$20,172.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,086.00
|
| Rate for Payer: Galaxy Health WC |
$21,432.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,693.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,818.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,606.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,043.00
|
| Rate for Payer: Multiplan Commercial |
$18,911.25
|
| Rate for Payer: Networks By Design Commercial |
$16,389.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,432.75
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
OP
|
$25,215.00
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
909022514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.53 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,938.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Distinction Transplant |
$15,129.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Cash Price |
$11,346.75
|
| Rate for Payer: Cash Price |
$11,346.75
|
| Rate for Payer: Central Health Plan Commercial |
$20,172.00
|
| Rate for Payer: Cigna of CA PPO |
$18,659.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$21,432.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,693.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,911.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,748.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: InnovAge PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,818.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,043.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$18,911.25
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$16,389.75
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Commercial |
$21,432.75
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health System MISP |
$9,832.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC PERQ VERTEBRAL AUGMENTATION
|
Facility
|
OP
|
$25,215.00
|
|
|
Service Code
|
CPT 22515
|
| Hospital Charge Code |
909022515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$370.67 |
| Max. Negotiated Rate |
$22,693.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,432.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,868.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,868.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$15,129.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Cash Price |
$11,346.75
|
| Rate for Payer: Cash Price |
$11,346.75
|
| Rate for Payer: Central Health Plan Commercial |
$20,172.00
|
| Rate for Payer: Cigna of CA PPO |
$18,659.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,432.75
|
| Rate for Payer: Dignity Health Media |
$21,432.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,432.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,086.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,086.00
|
| Rate for Payer: Galaxy Health WC |
$21,432.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,693.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,911.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,825.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,818.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,043.00
|
| Rate for Payer: Multiplan Commercial |
$18,911.25
|
| Rate for Payer: Networks By Design Commercial |
$16,389.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,432.75
|
| Rate for Payer: Riverside University Health System MISP |
$10,086.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,432.75
|
| Rate for Payer: Vantage Medical Group Senior |
$21,432.75
|
|
|
HC PERSIMMON IGE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC PERSIMMON IGE
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$140.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| 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 Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.27
|
| Rate for Payer: Blue Distinction Transplant |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$39.55
|
| Rate for Payer: Blue Shield of California EPN |
$31.10
|
| Rate for Payer: Caremore Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Media |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| 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 |
$12.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC PET/CT - TUMOR LIMITED AREA
|
Facility
|
IP
|
$12,338.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
909301483
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,467.60 |
| Max. Negotiated Rate |
$11,104.20 |
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,870.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,935.20
|
| Rate for Payer: Galaxy Health WC |
$10,487.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,402.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,104.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,229.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,700.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,467.60
|
| Rate for Payer: Multiplan Commercial |
$9,253.50
|
| Rate for Payer: Networks By Design Commercial |
$8,019.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,487.30
|
|
|
HC PET/CT - TUMOR LIMITED AREA
|
Facility
|
OP
|
$12,338.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
909301483
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,954.68 |
| Max. Negotiated Rate |
$11,104.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,954.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,775.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,289.29
|
| Rate for Payer: Blue Distinction Transplant |
$7,402.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,624.88
|
| Rate for Payer: Blue Shield of California EPN |
$5,996.27
|
| Rate for Payer: Caremore Medicare Advantage |
$1,954.68
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,870.40
|
| Rate for Payer: Cigna of CA HMO |
$7,896.32
|
| Rate for Payer: Cigna of CA PPO |
$9,130.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$10,487.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,402.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,104.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,253.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,225.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: InnovAge PACE Commercial |
$2,932.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,229.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,041.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,467.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,619.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$9,253.50
|
| Rate for Payer: Networks By Design Commercial |
$8,019.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,487.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,071.96
|
| Rate for Payer: Riverside University Health System MISP |
$2,150.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,402.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,402.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET/CT -TUMOR SKULL BASE-THIGH
|
Facility
|
OP
|
$13,275.00
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
909301484
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,954.68 |
| Max. Negotiated Rate |
$11,947.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,954.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,206.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,842.87
|
| Rate for Payer: Blue Distinction Transplant |
$7,965.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,203.95
|
| Rate for Payer: Blue Shield of California EPN |
$6,451.65
|
| Rate for Payer: Caremore Medicare Advantage |
$1,954.68
|
| Rate for Payer: Cash Price |
$5,973.75
|
| Rate for Payer: Cash Price |
$5,973.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,620.00
|
| Rate for Payer: Cigna of CA HMO |
$8,496.00
|
| Rate for Payer: Cigna of CA PPO |
$9,823.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$11,283.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,965.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,947.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,956.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,225.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: InnovAge PACE Commercial |
$2,932.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,854.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,041.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,655.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,619.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$9,956.25
|
| Rate for Payer: Networks By Design Commercial |
$8,628.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,283.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,071.96
|
| Rate for Payer: Riverside University Health System MISP |
$2,150.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,965.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,965.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC PET/CT -TUMOR SKULL BASE-THIGH
|
Facility
|
IP
|
$13,275.00
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
909301484
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,655.00 |
| Max. Negotiated Rate |
$11,947.50 |
| Rate for Payer: Cash Price |
$5,973.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,620.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,310.00
|
| Rate for Payer: Galaxy Health WC |
$11,283.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,965.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,947.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,854.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,057.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,655.00
|
| Rate for Payer: Multiplan Commercial |
$9,956.25
|
| Rate for Payer: Networks By Design Commercial |
$8,628.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,283.75
|
|
