|
HC APP SHORT LEG SPLINT
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
900501107
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$717.91
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,063.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,028.36
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,400.80
|
| Rate for Payer: Cigna of CA HMO |
$1,120.64
|
| Rate for Payer: Cigna of CA PPO |
$1,295.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$1,488.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,050.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,575.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,167.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$1,313.25
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$1,138.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$200.49
|
| Rate for Payer: Preferred Health Network WC |
$325.97
|
| Rate for Payer: Prime Health Services Commercial |
$1,488.35
|
| Rate for Payer: Prime Health Services Medicare |
$212.52
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,050.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,050.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC APP SHORT LEG SPLINT
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
900501107
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$350.20 |
| Max. Negotiated Rate |
$1,575.90 |
| Rate for Payer: Adventist Health Commercial |
$350.20
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,400.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.40
|
| Rate for Payer: EPIC Health Plan Senior |
$700.40
|
| Rate for Payer: Galaxy Health WC |
$1,488.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,050.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,575.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,167.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$667.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,083.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.20
|
| Rate for Payer: Multiplan Commercial |
$1,313.25
|
| Rate for Payer: Networks By Design Commercial |
$1,138.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,488.35
|
|
|
HC APP SKN SUB GRFT FRST 25 SQ CM
|
Facility
|
IP
|
$7,097.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
902315271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,419.40 |
| Max. Negotiated Rate |
$6,387.30 |
| Rate for Payer: Adventist Health Commercial |
$1,419.40
|
| Rate for Payer: Cash Price |
$3,903.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,677.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,838.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,838.80
|
| Rate for Payer: Galaxy Health WC |
$6,032.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,258.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,387.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,703.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,393.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.40
|
| Rate for Payer: Multiplan Commercial |
$5,322.75
|
| Rate for Payer: Networks By Design Commercial |
$4,613.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,032.45
|
|
|
HC APP SKN SUB GRFT FRST 25 SQ CM
|
Facility
|
OP
|
$7,097.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
902315271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.24 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$1,419.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,324.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,903.35
|
| Rate for Payer: Cash Price |
$3,903.35
|
| Rate for Payer: Cash Price |
$3,903.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,677.60
|
| Rate for Payer: Cigna of CA HMO |
$4,542.08
|
| Rate for Payer: Cigna of CA PPO |
$5,251.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$6,032.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,258.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,387.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$5,322.75
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$4,613.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$6,032.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,258.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC APP SURFACE NEUROSTIMULATOR MCAL
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
901300019
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC APP SURFACE NEUROSTIMULATOR MCAL
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
901300019
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$102.87 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$110.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: InnovAge PACE Commercial |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Riverside University Health System MISP |
$108.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC APP VENOUS WOUND COMP SYS KNEE
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
950420022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$118.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$200.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$285.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.51
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Central Health Plan Commercial |
$472.00
|
| Rate for Payer: Cigna of CA HMO |
$377.60
|
| Rate for Payer: Cigna of CA PPO |
$436.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$501.50
|
| Rate for Payer: Global Benefits Group Commercial |
$354.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$531.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$393.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$442.50
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$383.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$200.49
|
| Rate for Payer: Preferred Health Network WC |
$325.97
|
| Rate for Payer: Prime Health Services Commercial |
$501.50
|
| Rate for Payer: Prime Health Services Medicare |
$212.52
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC APP VENOUS WOUND COMP SYS KNEE
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
950420022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Adventist Health Commercial |
$118.00
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Central Health Plan Commercial |
$472.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.00
|
| Rate for Payer: EPIC Health Plan Senior |
$236.00
|
| Rate for Payer: Galaxy Health WC |
$501.50
|
| Rate for Payer: Global Benefits Group Commercial |
$354.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$531.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$393.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.00
|
| Rate for Payer: Multiplan Commercial |
$442.50
|
| Rate for Payer: Networks By Design Commercial |
$383.50
|
| Rate for Payer: Prime Health Services Commercial |
$501.50
|
|
|
HC AQUATIC THERAPY EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$108.00
|
|
| Hospital Charge Code |
900400041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.15 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$44.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$69.12
|
| Rate for Payer: Cigna of CA PPO |
$79.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: InnovAge PACE Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Riverside University Health System MISP |
$43.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.80
|
| Rate for Payer: Vantage Medical Group Senior |
$91.80
|
|
|
HC AQUATIC THERAPY EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$108.00
|
|
| Hospital Charge Code |
900400041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
905103142
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
905103142
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$100.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.96
|
| Rate for Payer: InnovAge PACE Commercial |
$123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Riverside University Health System MISP |
$98.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT COMM MCARE
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900417113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$100.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.96
|
| Rate for Payer: InnovAge PACE Commercial |
$123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Riverside University Health System MISP |
$98.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT COMM MCARE
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900417113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC ARCH AORTA
|
Facility
|
IP
|
$11,089.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
906820219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,217.80 |
| Max. Negotiated Rate |
$9,980.10 |
| Rate for Payer: Adventist Health Commercial |
$2,217.80
|
| Rate for Payer: Cash Price |
$6,098.95
|
| Rate for Payer: Central Health Plan Commercial |
$8,871.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,435.60
|
| Rate for Payer: Galaxy Health WC |
$9,425.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,653.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,980.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,396.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,224.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,864.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,217.80
|
| Rate for Payer: Multiplan Commercial |
$8,316.75
|
| Rate for Payer: Networks By Design Commercial |
$7,207.85
|
| Rate for Payer: Prime Health Services Commercial |
$9,425.65
|
|
|
HC ARCH AORTA
|
Facility
|
IP
|
$9,426.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
909020144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,885.20 |
| Max. Negotiated Rate |
$8,483.40 |
| Rate for Payer: Adventist Health Commercial |
$1,885.20
|
| Rate for Payer: Cash Price |
$5,184.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,540.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,770.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,770.40
|
| Rate for Payer: Galaxy Health WC |
$8,012.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,655.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,483.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,287.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,591.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,834.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,885.20
|
| Rate for Payer: Multiplan Commercial |
$7,069.50
|
| Rate for Payer: Networks By Design Commercial |
$6,126.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,012.10
|
|
|
HC ARCH AORTA
|
Facility
|
OP
|
$9,426.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
909020144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$299.04 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,885.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$5,184.30
|
| Rate for Payer: Cash Price |
$5,184.30
|
| Rate for Payer: Cash Price |
$5,184.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,540.80
|
| Rate for Payer: Cigna of CA HMO |
$6,032.64
|
| Rate for Payer: Cigna of CA PPO |
$6,975.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,012.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,655.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,483.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$299.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,287.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,885.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$7,069.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,126.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$8,012.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,655.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| 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 |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ARCH AORTA
|
Facility
|
OP
|
$11,089.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
906820219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$299.04 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,217.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$6,098.95
|
| Rate for Payer: Cash Price |
$6,098.95
|
| Rate for Payer: Cash Price |
$6,098.95
|
| Rate for Payer: Central Health Plan Commercial |
$8,871.20
|
| Rate for Payer: Cigna of CA HMO |
$7,096.96
|
| Rate for Payer: Cigna of CA PPO |
$8,205.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$9,425.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,653.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,980.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$299.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,396.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,217.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,316.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$7,207.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$9,425.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,653.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| 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 |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ARGON, THROMBEC CATH
|
Facility
|
OP
|
$2,827.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$2,544.75 |
| Rate for Payer: Adventist Health Commercial |
$565.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,555.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,291.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,565.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2,185.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,425.06
|
| Rate for Payer: Cash Price |
$1,555.13
|
| Rate for Payer: Central Health Plan Commercial |
$2,262.00
|
| Rate for Payer: Cigna of CA HMO |
$1,979.25
|
| Rate for Payer: Cigna of CA PPO |
$1,979.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,403.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,403.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.00
|
| Rate for Payer: Galaxy Health WC |
$2,403.38
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,544.75
|
| Rate for Payer: InnovAge PACE Commercial |
$1,413.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,885.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,750.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,979.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,979.25
|
| Rate for Payer: Multiplan Commercial |
$2,120.62
|
| Rate for Payer: Networks By Design Commercial |
$1,413.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.38
|
| Rate for Payer: Riverside University Health System MISP |
$1,131.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,696.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,696.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,061.16
|
| Rate for Payer: United Healthcare All Other HMO |
$1,032.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1,010.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.38
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.38
|
|
|
HC ARGON, THROMBEC CATH
|
Facility
|
IP
|
$2,827.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$2,544.75 |
| Rate for Payer: Adventist Health Commercial |
$565.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,185.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,425.06
|
| Rate for Payer: Cash Price |
$1,555.13
|
| Rate for Payer: Central Health Plan Commercial |
$2,262.00
|
| Rate for Payer: Cigna of CA HMO |
$1,979.25
|
| Rate for Payer: Cigna of CA PPO |
$1,979.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.00
|
| Rate for Payer: Galaxy Health WC |
$2,403.38
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,544.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,885.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,750.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.50
|
| Rate for Payer: Multiplan Commercial |
$2,120.62
|
| Rate for Payer: Networks By Design Commercial |
$1,413.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,061.16
|
| Rate for Payer: United Healthcare All Other HMO |
$1,032.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1,010.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.01
|
|
|
HC ARISTA HEMOSTAT
|
Facility
|
OP
|
$522.00
|
|
| Hospital Charge Code |
906812375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$469.80 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$317.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$252.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.57
|
| Rate for Payer: Blue Shield of California Commercial |
$318.94
|
| Rate for Payer: Blue Shield of California EPN |
$208.28
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$417.60
|
| Rate for Payer: Cigna of CA HMO |
$334.08
|
| Rate for Payer: Cigna of CA PPO |
$386.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$443.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.80
|
| Rate for Payer: InnovAge PACE Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$365.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$365.40
|
| Rate for Payer: Multiplan Commercial |
$391.50
|
| Rate for Payer: Networks By Design Commercial |
$339.30
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
| Rate for Payer: Riverside University Health System MISP |
$208.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$261.00
|
| Rate for Payer: United Healthcare HMO Rider |
$261.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.70
|
| Rate for Payer: Vantage Medical Group Senior |
$443.70
|
|
|
HC ARISTA HEMOSTAT
|
Facility
|
IP
|
$522.00
|
|
| Hospital Charge Code |
906812375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$469.80 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$417.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$391.50
|
| Rate for Payer: Networks By Design Commercial |
$339.30
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
OP
|
$892.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
906820179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$178.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$758.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$490.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$431.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$523.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$490.60
|
| Rate for Payer: Cash Price |
$490.60
|
| Rate for Payer: Cash Price |
$490.60
|
| Rate for Payer: Central Health Plan Commercial |
$713.60
|
| Rate for Payer: Cigna of CA HMO |
$570.88
|
| Rate for Payer: Cigna of CA PPO |
$660.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$758.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$758.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.80
|
| Rate for Payer: EPIC Health Plan Senior |
$356.80
|
| Rate for Payer: Galaxy Health WC |
$758.20
|
| Rate for Payer: Global Benefits Group Commercial |
$535.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$802.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.72
|
| Rate for Payer: InnovAge PACE Commercial |
$446.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$552.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$624.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$624.40
|
| Rate for Payer: Multiplan Commercial |
$669.00
|
| Rate for Payer: Networks By Design Commercial |
$579.80
|
| Rate for Payer: Prime Health Services Commercial |
$758.20
|
| Rate for Payer: Riverside University Health System MISP |
$356.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$535.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$758.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.20
|
| Rate for Payer: Vantage Medical Group Senior |
$758.20
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
909081322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$151.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$644.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$416.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$568.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$367.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$445.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$416.90
|
| Rate for Payer: Cash Price |
$416.90
|
| Rate for Payer: Cash Price |
$416.90
|
| Rate for Payer: Central Health Plan Commercial |
$606.40
|
| Rate for Payer: Cigna of CA HMO |
$485.12
|
| Rate for Payer: Cigna of CA PPO |
$560.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$644.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$644.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$644.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.20
|
| Rate for Payer: EPIC Health Plan Senior |
$303.20
|
| Rate for Payer: Galaxy Health WC |
$644.30
|
| Rate for Payer: Global Benefits Group Commercial |
$454.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$682.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.72
|
| Rate for Payer: InnovAge PACE Commercial |
$379.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$505.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.60
|
| Rate for Payer: Multiplan Commercial |
$568.50
|
| Rate for Payer: Networks By Design Commercial |
$492.70
|
| Rate for Payer: Prime Health Services Commercial |
$644.30
|
| Rate for Payer: Riverside University Health System MISP |
$303.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$454.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$644.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$644.30
|
| Rate for Payer: Vantage Medical Group Senior |
$644.30
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
909081322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$151.60 |
| Max. Negotiated Rate |
$682.20 |
| Rate for Payer: Adventist Health Commercial |
$151.60
|
| Rate for Payer: Cash Price |
$416.90
|
| Rate for Payer: Central Health Plan Commercial |
$606.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.20
|
| Rate for Payer: EPIC Health Plan Senior |
$303.20
|
| Rate for Payer: Galaxy Health WC |
$644.30
|
| Rate for Payer: Global Benefits Group Commercial |
$454.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$682.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$505.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.60
|
| Rate for Payer: Multiplan Commercial |
$568.50
|
| Rate for Payer: Networks By Design Commercial |
$492.70
|
| Rate for Payer: Prime Health Services Commercial |
$644.30
|
|
