|
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 |
$1.00 |
| Max. Negotiated Rate |
$25,134.15 |
| Rate for Payer: Adventist Health Commercial |
$4,977.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,096.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,228.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$11,198.70
|
| Rate for Payer: Cash Price |
$11,198.70
|
| Rate for Payer: Cash Price |
$11,198.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,175.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,551.35
|
| Rate for Payer: Dignity Health Senior |
$13,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,228.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,404.43
|
| Rate for Payer: Heritage Provider Network Senior |
$16,271.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$675.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,228.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25,134.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,504.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,212.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,221.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,667.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,667.91
|
| Rate for Payer: Multiplan Commercial |
$18,664.50
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,551.35
|
| Rate for Payer: TriValley Medical Group Senior |
$14,551.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Vantage Medical Group Senior |
$13,228.50
|
|
|
HC PERQ CERVICOTHORACIC INJECT
|
Facility
|
OP
|
$13,725.00
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
909022510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,293.75 |
| Rate for Payer: Adventist Health Commercial |
$2,745.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,429.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,921.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Senior |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,122.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,495.77
|
| Rate for Payer: Heritage Provider Network Senior |
$5,070.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$638.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,832.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,484.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,431.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,194.48
|
| Rate for Payer: Multiplan Commercial |
$10,293.75
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,534.86
|
| Rate for Payer: TriValley Medical Group Senior |
$4,534.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC PERQ CERVICOTHORACIC INJECT
|
Facility
|
IP
|
$13,725.00
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
909022510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,484.22 |
| Max. Negotiated Rate |
$10,293.75 |
| Rate for Payer: Adventist Health Commercial |
$2,745.00
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,484.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,431.25
|
| Rate for Payer: Multiplan Commercial |
$10,293.75
|
|
|
HC PERQ IMPL OF NEUROSTIM ELECT
|
Facility
|
IP
|
$29,782.00
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
900100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,390.54 |
| Max. Negotiated Rate |
$22,336.50 |
| Rate for Payer: Adventist Health Commercial |
$5,956.40
|
| Rate for Payer: Cash Price |
$13,401.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,162.41
|
| Rate for Payer: Heritage Provider Network Senior |
$20,162.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,390.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,445.50
|
| Rate for Payer: Multiplan Commercial |
$22,336.50
|
|
|
HC PERQ IMPL OF NEUROSTIM ELECT
|
Facility
|
OP
|
$29,782.00
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
900100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$22,336.50 |
| Rate for Payer: Adventist Health Commercial |
$5,956.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,460.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,508.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,172.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,338.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$13,401.90
|
| Rate for Payer: Cash Price |
$13,401.90
|
| Rate for Payer: Cash Price |
$13,401.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,358.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,508.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,172.70
|
| Rate for Payer: Dignity Health Senior |
$8,338.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,869.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,338.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,435.06
|
| Rate for Payer: Heritage Provider Network Senior |
$10,256.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$141.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,338.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,843.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,390.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,589.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,445.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,506.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,506.91
|
| Rate for Payer: Multiplan Commercial |
$22,336.50
|
| Rate for Payer: Multiplan WC |
$13,286.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,172.70
|
| Rate for Payer: TriValley Medical Group Senior |
$9,172.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,508.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,172.70
|
| Rate for Payer: Vantage Medical Group Senior |
$8,338.82
|
|
|
HC PERQ LUMBOSACRAL INJECT
|
Facility
|
IP
|
$13,725.00
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
909022511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,484.22 |
| Max. Negotiated Rate |
$10,293.75 |
| Rate for Payer: Adventist Health Commercial |
$2,745.00
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,484.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,431.25
|
| Rate for Payer: Multiplan Commercial |
$10,293.75
|
|
|
HC PERQ LUMBOSACRAL INJECT
|
Facility
|
OP
|
$13,725.00
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
909022511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,293.75 |
| Rate for Payer: Adventist Health Commercial |
$2,745.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,429.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Cash Price |
$6,176.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,921.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Senior |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,122.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,495.77
|
| Rate for Payer: Heritage Provider Network Senior |
$5,070.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,832.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,484.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,431.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,194.48
|
| Rate for Payer: Multiplan Commercial |
$10,293.75
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,534.86
|
| Rate for Payer: TriValley Medical Group Senior |
$4,534.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
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 |
$240.37 |
| Max. Negotiated Rate |
$996.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$899.06
|
| Rate for Payer: Heritage Provider Network Senior |
$899.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
|
|
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 |
$240.37 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$912.34
|
| 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 HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$863.20
|
| 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 Senior |
$1,128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$822.03
|
| Rate for Payer: Heritage Provider Network Senior |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$313.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$633.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$929.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| 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
|
OP
|
$28,772.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$24,456.20 |
| Rate for Payer: Adventist Health Commercial |
$5,754.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,766.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,456.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,824.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,579.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,680.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$12,947.40
|
| Rate for Payer: Cash Price |
$12,947.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,701.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,456.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,456.20
|
| Rate for Payer: Dignity Health Senior |
$24,456.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,263.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,809.87
|
| Rate for Payer: Heritage Provider Network Senior |
$17,809.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,724.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,193.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,140.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,140.40
|
| Rate for Payer: Multiplan Commercial |
$21,579.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,456.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,456.20
|
| Rate for Payer: Vantage Medical Group Senior |
$24,456.20
|
|
|
HC PERQ STEN/CHEST VERT ART
|
Facility
|
IP
|
$28,772.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,207.73 |
| Max. Negotiated Rate |
$21,579.00 |
| Rate for Payer: Adventist Health Commercial |
$5,754.40
|
| Rate for Payer: Cash Price |
$12,947.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,478.64
|
| Rate for Payer: Heritage Provider Network Senior |
$19,478.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,193.00
|
| Rate for Payer: Multiplan Commercial |
$21,579.00
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
IP
|
$41,241.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$30,930.75 |
| Rate for Payer: Adventist Health Commercial |
$8,248.20
|
| Rate for Payer: Cash Price |
$18,558.45
|
| Rate for Payer: Cash Price |
$18,558.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,464.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,310.25
|
| Rate for Payer: Multiplan Commercial |
$30,930.75
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
IP
|
$45,905.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906820005
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$34,428.75 |
| Rate for Payer: Adventist Health Commercial |
$9,181.00
|
| Rate for Payer: Cash Price |
$20,657.25
|
| Rate for Payer: Cash Price |
$20,657.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,308.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,476.25
|
| Rate for Payer: Multiplan Commercial |
$34,428.75
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
OP
|
$45,905.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906820005
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$9,181.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31,536.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$20,657.25
|
| Rate for Payer: Cash Price |
$20,657.25
|
| Rate for Payer: Cash Price |
$20,657.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,838.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,415.19
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$915.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,308.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,476.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$34,428.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,815.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
OP
|
$41,241.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$8,248.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,332.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$18,558.45
|
| Rate for Payer: Cash Price |
$18,558.45
|
| Rate for Payer: Cash Price |
$18,558.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,806.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,528.18
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$915.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,464.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,310.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$30,930.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,815.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
OP
|
$47,231.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
906820092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$9,446.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32,447.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$21,253.95
|
| Rate for Payer: Cash Price |
$21,253.95
|
| Rate for Payer: Cash Price |
$21,253.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,700.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$29,235.99
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,352.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,548.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,807.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$35,423.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,815.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,939.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
IP
|
$42,433.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$31,824.75 |
| Rate for Payer: Adventist Health Commercial |
$8,486.60
|
| Rate for Payer: Cash Price |
$19,094.85
|
| Rate for Payer: Cash Price |
$19,094.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,680.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,608.25
|
| Rate for Payer: Multiplan Commercial |
$31,824.75
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
OP
|
$42,433.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$8,486.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29,151.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$19,094.85
|
| Rate for Payer: Cash Price |
$19,094.85
|
| Rate for Payer: Cash Price |
$19,094.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,581.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,266.03
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,352.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,680.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,608.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$31,824.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,815.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,939.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
IP
|
$47,231.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
906820092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$35,423.25 |
| Rate for Payer: Adventist Health Commercial |
$9,446.20
|
| Rate for Payer: Cash Price |
$21,253.95
|
| Rate for Payer: Cash Price |
$21,253.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,548.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,807.75
|
| Rate for Payer: Multiplan Commercial |
$35,423.25
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
IP
|
$37,008.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906820301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$27,756.00 |
| Rate for Payer: Adventist Health Commercial |
$7,401.60
|
| Rate for Payer: Cash Price |
$16,653.60
|
| Rate for Payer: Cash Price |
$16,653.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,698.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,252.00
|
| Rate for Payer: Multiplan Commercial |
$27,756.00
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
OP
|
$37,008.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906820301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$7,401.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,424.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$16,653.60
|
| Rate for Payer: Cash Price |
$16,653.60
|
| Rate for Payer: Cash Price |
$16,653.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,055.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,907.95
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,629.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,698.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,252.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$27,756.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,815.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,939.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
IP
|
$31,457.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$23,592.75 |
| Rate for Payer: Adventist Health Commercial |
$6,291.40
|
| Rate for Payer: Cash Price |
$14,155.65
|
| Rate for Payer: Cash Price |
$14,155.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,693.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,864.25
|
| Rate for Payer: Multiplan Commercial |
$23,592.75
|
|
|
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 |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$6,291.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,610.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$14,155.65
|
| Rate for Payer: Cash Price |
$14,155.65
|
| Rate for Payer: Cash Price |
$14,155.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,447.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,471.88
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,629.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,693.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,864.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$23,592.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,815.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,939.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
IP
|
$17,783.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,218.72 |
| Max. Negotiated Rate |
$13,337.25 |
| Rate for Payer: Adventist Health Commercial |
$3,556.60
|
| Rate for Payer: Cash Price |
$8,002.35
|
| Rate for Payer: Cash Price |
$8,002.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,218.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,445.75
|
| Rate for Payer: Multiplan Commercial |
$13,337.25
|
|
|
HC PERQ TRNSCTH CLSRE EA OCC DVC
|
Facility
|
OP
|
$17,783.00
|
|
|
Service Code
|
CPT 93592
|
| Hospital Charge Code |
906811592
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$15,115.55 |
| Rate for Payer: Adventist Health Commercial |
$3,556.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,216.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,115.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,780.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,337.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$8,002.35
|
| Rate for Payer: Cash Price |
$8,002.35
|
| Rate for Payer: Cash Price |
$8,002.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,115.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,115.55
|
| Rate for Payer: Dignity Health Senior |
$15,115.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,558.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,007.68
|
| Rate for Payer: Heritage Provider Network Senior |
$11,007.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$595.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,482.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,218.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,445.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,448.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,448.10
|
| Rate for Payer: Multiplan Commercial |
$13,337.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,115.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,115.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15,115.55
|
|
