Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913

Facility

OP

$1,150.00

Service Code	ICD F50.01
Hospital Revenue Code	913
Min. Negotiated Rate	$943.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Blue Shield of California Commercial	$978.00
Rate for Payer: Blue Shield of California EPN	$943.00
Rate for Payer: Health Net Behavioral	$1,150.00

Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913

Facility

OP

$1,150.00

Service Code	ICD F50.2
Hospital Revenue Code	913
Min. Negotiated Rate	$943.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Blue Shield of California Commercial	$978.00
Rate for Payer: Blue Shield of California EPN	$943.00
Rate for Payer: Health Net Behavioral	$1,150.00

Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913

Facility

OP

$1,150.00

Service Code	ICD F50.2
Hospital Revenue Code	912
Min. Negotiated Rate	$943.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Blue Shield of California Commercial	$978.00
Rate for Payer: Blue Shield of California EPN	$943.00
Rate for Payer: Health Net Behavioral	$1,150.00

Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913

Facility

OP

$1,150.00

Service Code	ICD F50.0
Hospital Revenue Code	912
Min. Negotiated Rate	$943.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Blue Shield of California Commercial	$978.00
Rate for Payer: Blue Shield of California EPN	$943.00
Rate for Payer: Health Net Behavioral	$1,150.00

Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913

Facility

OP

$1,150.00

Service Code	ICD F50.01
Hospital Revenue Code	912
Min. Negotiated Rate	$943.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Blue Shield of California Commercial	$978.00
Rate for Payer: Blue Shield of California EPN	$943.00
Rate for Payer: Health Net Behavioral	$1,150.00

Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913

Facility

OP

$1,150.00

Service Code	ICD F50.8
Hospital Revenue Code	913
Min. Negotiated Rate	$943.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Blue Shield of California Commercial	$978.00
Rate for Payer: Blue Shield of California EPN	$943.00
Rate for Payer: Health Net Behavioral	$1,150.00

Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913

Facility

OP

$1,150.00

Service Code	ICD F98.21
Hospital Revenue Code	913
Min. Negotiated Rate	$943.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Blue Shield of California Commercial	$978.00
Rate for Payer: Blue Shield of California EPN	$943.00
Rate for Payer: Health Net Behavioral	$1,150.00

Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913

Facility

OP

$1,150.00

Service Code	ICD F50.9
Hospital Revenue Code	913
Min. Negotiated Rate	$943.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Blue Shield of California Commercial	$978.00
Rate for Payer: Blue Shield of California EPN	$943.00
Rate for Payer: Health Net Behavioral	$1,150.00

Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913

Facility

OP

$1,150.00

Service Code	ICD F98.29
Hospital Revenue Code	912
Min. Negotiated Rate	$943.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Blue Shield of California Commercial	$978.00
Rate for Payer: Blue Shield of California EPN	$943.00
Rate for Payer: Health Net Behavioral	$1,150.00

Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913

Facility

OP

$1,150.00

Service Code	ICD F50.02
Hospital Revenue Code	913
Min. Negotiated Rate	$943.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Blue Shield of California Commercial	$978.00
Rate for Payer: Blue Shield of California EPN	$943.00
Rate for Payer: Health Net Behavioral	$1,150.00

Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913

Facility

OP

$1,150.00

Service Code	ICD F50.0
Hospital Revenue Code	913
Min. Negotiated Rate	$943.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Blue Shield of California Commercial	$978.00
Rate for Payer: Blue Shield of California EPN	$943.00
Rate for Payer: Health Net Behavioral	$1,150.00

Partial Hospitalization, Eating Disorders - Must be billed w/ specific diagnosis codes in addition to rev codes 912 or 913

Facility

OP

$1,150.00

Service Code	ICD F50.8
Hospital Revenue Code	912
Min. Negotiated Rate	$943.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Blue Shield of California Commercial	$978.00
Rate for Payer: Blue Shield of California EPN	$943.00
Rate for Payer: Health Net Behavioral	$1,150.00

Partial Hospitalization - Must be billed w/ specific diagnosis codes in addition to rev code 912

Facility

OP

$674.00

Service Code	CPT 90834
Hospital Revenue Code	912
Min. Negotiated Rate	$626.00
Max. Negotiated Rate	$674.00
Rate for Payer: Blue Shield of California Commercial	$626.00
Rate for Payer: Blue Shield of California Commercial	$699.00
Rate for Payer: Blue Shield of California EPN	$603.00
Rate for Payer: Blue Shield of California EPN	$674.00

Partial Hospitalization - Must be billed w/ specific diagnosis codes in addition to rev code 912

Facility

OP

$674.00

Service Code	CPT 90853
Hospital Revenue Code	912
Min. Negotiated Rate	$626.00
Max. Negotiated Rate	$674.00
Rate for Payer: Blue Shield of California EPN	$603.00
Rate for Payer: Blue Shield of California EPN	$674.00
Rate for Payer: Blue Shield of California Commercial	$626.00
Rate for Payer: Blue Shield of California Commercial	$699.00

Partial Hospitalization - Must be billed w/ specific diagnosis codes in addition to rev code 912

Facility

OP

$674.00

Service Code	CPT 90847
Hospital Revenue Code	912
Min. Negotiated Rate	$626.00
Max. Negotiated Rate	$674.00
Rate for Payer: Blue Shield of California Commercial	$626.00
Rate for Payer: Blue Shield of California Commercial	$699.00
Rate for Payer: Blue Shield of California EPN	$603.00
Rate for Payer: Blue Shield of California EPN	$674.00

Partial Hospitalization - Must be billed w/ specific diagnosis codes in addition to rev code 912

Facility

OP

$674.00

Service Code	CPT 96100
Hospital Revenue Code	912
Min. Negotiated Rate	$626.00
Max. Negotiated Rate	$674.00
Rate for Payer: Blue Shield of California Commercial	$626.00
Rate for Payer: Blue Shield of California EPN	$674.00

Partial Hospitalization - Must be billed w/ specific diagnosis codes in addition to rev code 912

Facility

OP

$674.00

Service Code	CPT 90899
Hospital Revenue Code	912
Min. Negotiated Rate	$626.00
Max. Negotiated Rate	$674.00
Rate for Payer: Blue Shield of California Commercial	$626.00
Rate for Payer: Blue Shield of California Commercial	$699.00
Rate for Payer: Blue Shield of California EPN	$603.00
Rate for Payer: Blue Shield of California EPN	$674.00

Partial Hospitalization Substance Abuse - Must be billed w/ specific diagnosis codes in addition to rev code 912

Facility

OP

$699.00

Service Code	CPT 96100
Hospital Revenue Code	912
Min. Negotiated Rate	$603.00
Max. Negotiated Rate	$699.00
Rate for Payer: Blue Shield of California Commercial	$699.00
Rate for Payer: Blue Shield of California EPN	$603.00

PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT

Facility

IP

$17,845.73

Service Code	APR-DRG 8443
Min. Negotiated Rate	$11,270.99
Max. Negotiated Rate	$17,845.73
Rate for Payer: Adventist Health Medi-Cal	$11,270.99
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$13,431.26
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$17,845.73

PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT

Facility

IP

$36,783.14

Service Code	APR-DRG 8444
Min. Negotiated Rate	$23,231.46
Max. Negotiated Rate	$36,783.14
Rate for Payer: Adventist Health Medi-Cal	$23,231.46
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$27,684.16
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$36,783.14

PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT

Facility

IP

$5,949.93

Service Code	APR-DRG 8441
Min. Negotiated Rate	$3,757.85
Max. Negotiated Rate	$5,949.93
Rate for Payer: Adventist Health Medi-Cal	$3,757.85
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$4,478.10
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$5,949.93

PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT

Facility

IP

$10,328.76

Service Code	APR-DRG 8442
Min. Negotiated Rate	$6,523.43
Max. Negotiated Rate	$10,328.76
Rate for Payer: Adventist Health Medi-Cal	$6,523.43
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$7,773.75
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$10,328.76

PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY

Facility

OP

$28,817.00

Service Code	CPT 60210
Hospital Revenue Code	360
Min. Negotiated Rate	$194.03
Max. Negotiated Rate	$28,817.00
Rate for Payer: Adventist Health Medi-Cal	$7,775.56
Rate for Payer: Aetna of CA HMO/PPO	$27,467.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$11,663.34
Rate for Payer: Alpha Care Medical Group Medi-Cal	$8,553.12
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$7,775.56
Rate for Payer: Anthem Blue Cross of CA Exchange	$4,736.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$6,587.00
Rate for Payer: Anthem Blue Cross of CA Workers' Comp	$11,811.52
Rate for Payer: Blue Shield of California Commercial	$9,831.25
Rate for Payer: Blue Shield of California EPN	$6,179.04
Rate for Payer: Dignity Health Commercial/Exchange	$11,663.34
Rate for Payer: Dignity Health Medi-Cal	$8,553.12
Rate for Payer: Dignity Health Medicare Advantage	$7,775.56
Rate for Payer: EPIC Health Plan Commercial	$12,829.67
Rate for Payer: EPIC Health Plan Senior	$8,553.12
Rate for Payer: Heritage Provider Network Commercial/Senior	$12,751.92
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$194.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,775.56
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$214.34
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$10,885.78
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$10,419.25
Rate for Payer: Multiplan WC	$11,811.52
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$7,775.56
Rate for Payer: Preferred Health Network WC	$12,052.57
Rate for Payer: Prime Health Services Medicare	$8,242.09
Rate for Payer: Prime Health Services WC	$11,690.99
Rate for Payer: Riverside University Health System MISP	$8,553.12
Rate for Payer: United Healthcare All Other HMO	$28,817.00
Rate for Payer: United Healthcare HMO Rider	$18,075.00
Rate for Payer: United Healthcare Select/Navigate/Core	$16,561.00
Rate for Payer: Upland Medical Group Pediatric	$7,775.56
Rate for Payer: Vantage Medical Group Commercial/Exchange	$11,663.34
Rate for Payer: Vantage Medical Group Medi-Cal	$8,553.12
Rate for Payer: Vantage Medical Group Senior	$7,775.56

PATELLECTOMY OR HEMIPATELLECTOMY

Facility

OP

$27,467.00

Service Code	CPT 27350
Hospital Revenue Code	360
Min. Negotiated Rate	$174.18
Max. Negotiated Rate	$27,467.00
Rate for Payer: Adventist Health Medi-Cal	$9,332.70
Rate for Payer: Aetna of CA HMO/PPO	$27,467.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$13,999.05
Rate for Payer: Alpha Care Medical Group Medi-Cal	$10,265.97
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$9,332.70
Rate for Payer: Anthem Blue Cross of CA Exchange	$6,419.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,924.00
Rate for Payer: Anthem Blue Cross of CA Workers' Comp	$14,462.30
Rate for Payer: Blue Shield of California Commercial	$6,228.07
Rate for Payer: Blue Shield of California EPN	$3,914.40
Rate for Payer: Dignity Health Commercial/Exchange	$13,999.05
Rate for Payer: Dignity Health Medi-Cal	$10,265.97
Rate for Payer: Dignity Health Medicare Advantage	$9,332.70
Rate for Payer: EPIC Health Plan Commercial	$15,398.95
Rate for Payer: EPIC Health Plan Senior	$10,265.97
Rate for Payer: Heritage Provider Network Commercial/Senior	$15,305.63
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$174.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,332.70
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$192.41
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$13,065.78
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$12,505.82
Rate for Payer: Multiplan WC	$14,462.30
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$9,332.70
Rate for Payer: Preferred Health Network WC	$14,757.45
Rate for Payer: Prime Health Services Medicare	$9,892.66
Rate for Payer: Prime Health Services WC	$14,314.73
Rate for Payer: Riverside University Health System MISP	$10,265.97
Rate for Payer: United Healthcare All Other HMO	$20,902.00
Rate for Payer: United Healthcare HMO Rider	$13,066.00
Rate for Payer: United Healthcare Select/Navigate/Core	$11,971.00
Rate for Payer: Upland Medical Group Pediatric	$9,332.70
Rate for Payer: Vantage Medical Group Commercial/Exchange	$13,999.05
Rate for Payer: Vantage Medical Group Medi-Cal	$10,265.97
Rate for Payer: Vantage Medical Group Senior	$9,332.70

PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC

Facility

IP

$27,055.93

Service Code	MSDRG 543
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$27,055.93
Rate for Payer: Aetna of CA HMO/PPO	$27,055.93
Rate for Payer: Anthem Blue Cross of CA Exchange	$17,477.03
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$24,468.46
Rate for Payer: EPIC Health Plan Commercial	$24,881.69
Rate for Payer: EPIC Health Plan Senior	$16,587.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,079.81
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$21,111.73
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$20,206.95
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$15,079.81
Rate for Payer: Prime Health Services Medicare	$15,984.60
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00