|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.08 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
|
|
HC PSYCH 45 MIN W PT W EVAL
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
900100704
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.16 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
|
|
HC PSYCH 45 MIN W PT W EVAL
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
900100704
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.16 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$275.40
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cigna of CA PPO |
$339.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.15
|
| Rate for Payer: Dignity Health Media |
$390.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$390.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$344.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.50
|
| Rate for Payer: United Healthcare All Other HMO |
$229.50
|
| Rate for Payer: United Healthcare HMO Rider |
$229.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$390.15
|
| Rate for Payer: Vantage Medical Group Senior |
$390.15
|
|
|
HC PSYCH 60 MIN W PT W EVAL
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
900100705
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.68 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
|
|
HC PSYCH 60 MIN W PT W EVAL
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
900100705
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.68 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$265.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$289.20
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA PPO |
$356.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.70
|
| Rate for Payer: Dignity Health Media |
$409.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$361.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.00
|
| Rate for Payer: United Healthcare All Other HMO |
$241.00
|
| Rate for Payer: United Healthcare HMO Rider |
$241.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.70
|
| Rate for Payer: Vantage Medical Group Senior |
$409.70
|
|
|
HC PSYCH CRISIS EA ADD 30 MIN
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
900100707
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$110.40
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Media |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$138.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.00
|
| Rate for Payer: United Healthcare All Other HMO |
$92.00
|
| Rate for Payer: United Healthcare HMO Rider |
$92.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PSYCH CRISIS EA ADD 30 MIN
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
900100707
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PSYCH CRISIS FIRST 60 MIN
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
900100706
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.22 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$220.20
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA PPO |
$271.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.82
|
| Rate for Payer: Dignity Health Media |
$199.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$199.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.21
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$275.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$326.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$199.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$251.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.94
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.50
|
| Rate for Payer: United Healthcare All Other HMO |
$183.50
|
| Rate for Payer: United Healthcare HMO Rider |
$183.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Vantage Medical Group Senior |
$199.21
|
|
|
HC PSYCH CRISIS FIRST 60 MIN
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
900100706
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.08 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
|
|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
900100702
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.16 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
|
|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
900100702
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.16 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$275.40
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cigna of CA PPO |
$339.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.82
|
| Rate for Payer: Dignity Health Media |
$199.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$199.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.21
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$344.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$326.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$199.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$251.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.94
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.50
|
| Rate for Payer: United Healthcare All Other HMO |
$229.50
|
| Rate for Payer: United Healthcare HMO Rider |
$229.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Vantage Medical Group Senior |
$199.21
|
|
|
HC PTA FEM/POP
|
Facility
|
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
909020065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$740.03 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cigna of CA PPO |
$11,928.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Media |
$7,141.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,090.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,711.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,711.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,568.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,568.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$740.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,868.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$12,896.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,672.00
|
| 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 |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTA FEM/POP
|
Facility
|
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
909020065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,868.80 |
| Max. Negotiated Rate |
$13,702.00 |
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,141.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,868.80
|
| Rate for Payer: Multiplan Commercial |
$12,896.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
|
|
HC PTA ILIAC
|
Facility
|
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,868.80 |
| Max. Negotiated Rate |
$13,702.00 |
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,141.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,868.80
|
| Rate for Payer: Multiplan Commercial |
$12,896.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
|
|
HC PTA ILIAC
|
Facility
|
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$671.42 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cigna of CA PPO |
$11,928.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Media |
$7,141.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,090.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,711.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,711.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,568.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,568.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$671.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,868.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$12,896.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,672.00
|
| 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 |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,675.36 |
| Max. Negotiated Rate |
$13,016.90 |
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.59 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,422.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Media |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,485.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| 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 |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC PTA INTRACRAN VASO EA ADD DIFF
|
Facility
|
IP
|
$6,830.00
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
909081017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,639.20 |
| Max. Negotiated Rate |
$5,805.50 |
| Rate for Payer: Cash Price |
$3,073.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,732.00
|
| Rate for Payer: Galaxy Health WC |
$5,805.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,098.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,555.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,602.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,639.20
|
| Rate for Payer: Multiplan Commercial |
$5,464.00
|
| Rate for Payer: Networks By Design Commercial |
$4,439.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,805.50
|
|
|
HC PTA INTRACRAN VASO EA ADD DIFF
|
Facility
|
OP
|
$6,830.00
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
909081017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,639.20 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,658.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,805.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,756.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,756.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,098.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$3,073.50
|
| Rate for Payer: Cash Price |
$3,073.50
|
| Rate for Payer: Cash Price |
$3,073.50
|
| Rate for Payer: Cigna of CA PPO |
$5,054.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,805.50
|
| Rate for Payer: Dignity Health Media |
$5,805.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,805.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,732.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,732.00
|
| Rate for Payer: Galaxy Health WC |
$5,805.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,098.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,555.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,639.20
|
| Rate for Payer: Multiplan Commercial |
$5,464.00
|
| Rate for Payer: Networks By Design Commercial |
$4,439.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,805.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,098.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,805.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,805.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,805.50
|
|
|
HC PTA INTRACRAN VASOPAMS EA ADDL
|
Facility
|
IP
|
$7,658.00
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
909081016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,837.92 |
| Max. Negotiated Rate |
$6,509.30 |
| Rate for Payer: Cash Price |
$3,446.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,063.20
|
| Rate for Payer: Galaxy Health WC |
$6,509.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,594.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,107.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,917.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,837.92
|
| Rate for Payer: Multiplan Commercial |
$6,126.40
|
| Rate for Payer: Networks By Design Commercial |
$4,977.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,509.30
|
|
|
HC PTA INTRACRAN VASOPAMS EA ADDL
|
Facility
|
OP
|
$7,658.00
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
909081016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,331.00 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,331.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,509.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,211.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,211.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,594.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$3,446.10
|
| Rate for Payer: Cash Price |
$3,446.10
|
| Rate for Payer: Cash Price |
$3,446.10
|
| Rate for Payer: Cigna of CA PPO |
$5,666.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,509.30
|
| Rate for Payer: Dignity Health Media |
$6,509.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,509.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,063.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,063.20
|
| Rate for Payer: Galaxy Health WC |
$6,509.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,594.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,743.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,107.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,837.92
|
| Rate for Payer: Multiplan Commercial |
$6,126.40
|
| Rate for Payer: Networks By Design Commercial |
$4,977.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,509.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,594.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,509.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,509.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,509.30
|
|
|
HC PTA INTRACRAN VASOSPASM
|
Facility
|
OP
|
$15,288.00
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
909081015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,257.00 |
| Max. Negotiated Rate |
$12,994.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,784.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,994.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,408.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,408.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,172.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$6,879.60
|
| Rate for Payer: Cash Price |
$6,879.60
|
| Rate for Payer: Cash Price |
$6,879.60
|
| Rate for Payer: Cigna of CA PPO |
$11,313.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,994.80
|
| Rate for Payer: Dignity Health Media |
$12,994.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,994.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,115.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,115.20
|
| Rate for Payer: Galaxy Health WC |
$12,994.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,172.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,466.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,197.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,669.12
|
| Rate for Payer: Multiplan Commercial |
$12,230.40
|
| Rate for Payer: Networks By Design Commercial |
$9,937.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,994.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,994.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,994.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,994.80
|
|
|
HC PTA INTRACRAN VASOSPASM
|
Facility
|
IP
|
$15,288.00
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
909081015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,669.12 |
| Max. Negotiated Rate |
$12,994.80 |
| Rate for Payer: Cash Price |
$6,879.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,115.20
|
| Rate for Payer: Galaxy Health WC |
$12,994.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,197.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,824.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,669.12
|
| Rate for Payer: Multiplan Commercial |
$12,230.40
|
| Rate for Payer: Networks By Design Commercial |
$9,937.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,994.80
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
IP
|
$14,368.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,448.32 |
| Max. Negotiated Rate |
$12,212.80 |
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,747.20
|
| Rate for Payer: Galaxy Health WC |
$12,212.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,620.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,583.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,474.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,448.32
|
| Rate for Payer: Multiplan Commercial |
$11,494.40
|
| Rate for Payer: Networks By Design Commercial |
$9,339.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,212.80
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
OP
|
$14,368.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$902.98 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,620.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Cigna of CA PPO |
$10,632.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$12,212.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,620.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,776.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,583.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$902.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,448.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$11,494.40
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$9,339.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,212.80
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,620.80
|
| 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 |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
