|
HC EVL/TRTMT MH OR SUB USE DISORDER REMOTE EA ADD 15 MIN
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT C7902
|
| Hospital Charge Code |
907807902
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.11
|
| Rate for Payer: Blue Shield of California Commercial |
$81.26
|
| Rate for Payer: Blue Shield of California EPN |
$53.07
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Cigna of CA HMO |
$85.12
|
| Rate for Payer: Cigna of CA PPO |
$98.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: InnovAge PACE Commercial |
$66.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.10
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: Riverside University Health System MISP |
$53.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.50
|
| Rate for Payer: United Healthcare All Other HMO |
$66.50
|
| Rate for Payer: United Healthcare HMO Rider |
$66.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.05
|
| Rate for Payer: Vantage Medical Group Senior |
$113.05
|
|
|
HC EVL/TRTMT MH OR SUB USE DISORDER REMOTE EA ADD 15 MIN
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT C7902
|
| Hospital Charge Code |
907807902
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
|
|
HC EV VEN ATLIZTN TBL OR PRL VEIN
|
Facility
|
OP
|
$40,008.00
|
|
|
Service Code
|
CPT 0620T
|
| Hospital Charge Code |
909000620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$72,933.49 |
| Rate for Payer: Adventist Health Commercial |
$8,001.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$44,471.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66,707.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48,918.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44,471.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19,371.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,496.70
|
| 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 |
$22,004.40
|
| Rate for Payer: Cash Price |
$22,004.40
|
| Rate for Payer: Cash Price |
$22,004.40
|
| Rate for Payer: Central Health Plan Commercial |
$32,006.40
|
| Rate for Payer: Cigna of CA HMO |
$25,605.12
|
| Rate for Payer: Cigna of CA PPO |
$29,605.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66,707.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$48,918.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44,471.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$60,036.71
|
| Rate for Payer: EPIC Health Plan Senior |
$44,471.64
|
| Rate for Payer: Galaxy Health WC |
$34,006.80
|
| Rate for Payer: Global Benefits Group Commercial |
$24,004.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,007.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$72,933.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44,471.64
|
| Rate for Payer: InnovAge PACE Commercial |
$66,707.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,685.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,243.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44,471.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,001.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59,592.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59,592.00
|
| Rate for Payer: Multiplan Commercial |
$30,006.00
|
| Rate for Payer: Networks By Design Commercial |
$26,005.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$44,471.64
|
| Rate for Payer: Prime Health Services Commercial |
$34,006.80
|
| Rate for Payer: Prime Health Services Medicare |
$47,139.94
|
| Rate for Payer: Riverside University Health System MISP |
$48,918.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24,004.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$44,471.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66,707.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48,918.80
|
| Rate for Payer: Vantage Medical Group Senior |
$44,471.64
|
|
|
HC EV VEN ATLIZTN TBL OR PRL VEIN
|
Facility
|
IP
|
$40,008.00
|
|
|
Service Code
|
CPT 0620T
|
| Hospital Charge Code |
909000620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,001.60 |
| Max. Negotiated Rate |
$36,007.20 |
| Rate for Payer: Adventist Health Commercial |
$8,001.60
|
| Rate for Payer: Cash Price |
$22,004.40
|
| Rate for Payer: Central Health Plan Commercial |
$32,006.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,003.20
|
| Rate for Payer: EPIC Health Plan Senior |
$16,003.20
|
| Rate for Payer: Galaxy Health WC |
$34,006.80
|
| Rate for Payer: Global Benefits Group Commercial |
$24,004.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,007.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,685.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,243.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,764.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,001.60
|
| Rate for Payer: Multiplan Commercial |
$30,006.00
|
| Rate for Payer: Networks By Design Commercial |
$26,005.20
|
| Rate for Payer: Prime Health Services Commercial |
$34,006.80
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
905353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$627.16 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,124.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,480.30
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.71
|
| Rate for Payer: InnovAge PACE Commercial |
$957.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$785.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Riverside University Health System MISP |
$766.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
915353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$627.16 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,124.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,480.30
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.71
|
| Rate for Payer: InnovAge PACE Commercial |
$957.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$785.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Riverside University Health System MISP |
$766.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
905353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,480.30
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.00
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$1,244.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
915353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,480.30
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.00
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$1,244.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
915353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Adventist Health Commercial |
$405.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,565.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,020.60
|
| Rate for Payer: Cash Price |
$1,113.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.00
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,822.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,253.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,518.75
|
| Rate for Payer: Networks By Design Commercial |
$1,316.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
905353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Adventist Health Commercial |
$405.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,565.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,020.60
|
| Rate for Payer: Cash Price |
$1,113.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.00
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,822.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,253.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,518.75
|
| Rate for Payer: Networks By Design Commercial |
$1,316.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
OP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
915353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$663.19 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Adventist Health Commercial |
$830.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,113.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,518.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,189.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,565.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,020.60
|
| Rate for Payer: Cash Price |
$1,113.75
|
| Rate for Payer: Cash Price |
$1,113.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.00
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,721.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,721.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,822.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,336.06
|
| Rate for Payer: InnovAge PACE Commercial |
$1,012.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,253.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,417.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,417.50
|
| Rate for Payer: Multiplan Commercial |
$1,518.75
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: Riverside University Health System MISP |
$810.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,215.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,721.25
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
OP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
905353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$663.19 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Adventist Health Commercial |
$830.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,113.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,518.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,189.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,565.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,020.60
|
| Rate for Payer: Cash Price |
$1,113.75
|
| Rate for Payer: Cash Price |
$1,113.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.00
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,721.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,721.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,822.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,336.06
|
| Rate for Payer: InnovAge PACE Commercial |
$1,012.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,253.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,417.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,417.50
|
| Rate for Payer: Multiplan Commercial |
$1,518.75
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: Riverside University Health System MISP |
$810.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,215.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,721.25
|
|
|
HC EWHO COMB HUMERAL RADIUS ULNAR WRIS
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
903203986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$356.40 |
| Rate for Payer: Adventist Health Commercial |
$79.20
|
| Rate for Payer: Blue Shield of California Commercial |
$306.11
|
| Rate for Payer: Blue Shield of California EPN |
$199.58
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Central Health Plan Commercial |
$316.80
|
| Rate for Payer: Cigna of CA HMO |
$277.20
|
| Rate for Payer: Cigna of CA PPO |
$277.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.40
|
| Rate for Payer: EPIC Health Plan Senior |
$158.40
|
| Rate for Payer: Galaxy Health WC |
$336.60
|
| Rate for Payer: Global Benefits Group Commercial |
$237.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$356.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$264.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$245.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$297.00
|
| Rate for Payer: Networks By Design Commercial |
$257.40
|
| Rate for Payer: Prime Health Services Commercial |
$336.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.62
|
| Rate for Payer: United Healthcare All Other HMO |
$144.66
|
| Rate for Payer: United Healthcare HMO Rider |
$141.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.69
|
|
|
HC EWHO COMB HUMERAL RADIUS ULNAR WRIS
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
903203986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.69 |
| Max. Negotiated Rate |
$1,393.74 |
| Rate for Payer: Adventist Health Commercial |
$162.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$336.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$297.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.57
|
| Rate for Payer: Blue Shield of California Commercial |
$306.11
|
| Rate for Payer: Blue Shield of California EPN |
$199.58
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Central Health Plan Commercial |
$316.80
|
| Rate for Payer: Cigna of CA HMO |
$277.20
|
| Rate for Payer: Cigna of CA PPO |
$277.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$336.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$336.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.40
|
| Rate for Payer: EPIC Health Plan Senior |
$158.40
|
| Rate for Payer: Galaxy Health WC |
$336.60
|
| Rate for Payer: Global Benefits Group Commercial |
$237.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$356.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.71
|
| Rate for Payer: InnovAge PACE Commercial |
$198.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$264.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$245.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$277.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$277.20
|
| Rate for Payer: Multiplan Commercial |
$297.00
|
| Rate for Payer: Networks By Design Commercial |
$198.00
|
| Rate for Payer: Prime Health Services Commercial |
$336.60
|
| Rate for Payer: Riverside University Health System MISP |
$158.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$237.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$237.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.62
|
| Rate for Payer: United Healthcare All Other HMO |
$144.66
|
| Rate for Payer: United Healthcare HMO Rider |
$141.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$336.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.60
|
| Rate for Payer: Vantage Medical Group Senior |
$336.60
|
|
|
HC EWHO FX OX COLLES FX
|
Facility
|
IP
|
$2,053.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
905353986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$410.60 |
| Max. Negotiated Rate |
$1,847.70 |
| Rate for Payer: Adventist Health Commercial |
$410.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,586.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,034.71
|
| Rate for Payer: Cash Price |
$1,129.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,642.40
|
| Rate for Payer: Cigna of CA HMO |
$1,437.10
|
| Rate for Payer: Cigna of CA PPO |
$1,437.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$821.20
|
| Rate for Payer: EPIC Health Plan Senior |
$821.20
|
| Rate for Payer: Galaxy Health WC |
$1,745.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,231.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,847.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,369.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$782.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,270.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.60
|
| Rate for Payer: Multiplan Commercial |
$1,539.75
|
| Rate for Payer: Networks By Design Commercial |
$1,334.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,745.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$770.49
|
| Rate for Payer: United Healthcare All Other HMO |
$749.96
|
| Rate for Payer: United Healthcare HMO Rider |
$733.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$672.36
|
|
|
HC EWHO FX OX COLLES FX
|
Facility
|
OP
|
$2,053.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
905353986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$672.36 |
| Max. Negotiated Rate |
$1,847.70 |
| Rate for Payer: Adventist Health Commercial |
$841.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,745.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,129.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,205.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,586.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,034.71
|
| Rate for Payer: Cash Price |
$1,129.15
|
| Rate for Payer: Cash Price |
$1,129.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,642.40
|
| Rate for Payer: Cigna of CA HMO |
$1,437.10
|
| Rate for Payer: Cigna of CA PPO |
$1,437.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,745.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,745.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,745.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$821.20
|
| Rate for Payer: EPIC Health Plan Senior |
$821.20
|
| Rate for Payer: Galaxy Health WC |
$1,745.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,231.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,847.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,026.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,369.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,270.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,437.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,437.10
|
| Rate for Payer: Multiplan Commercial |
$1,539.75
|
| Rate for Payer: Networks By Design Commercial |
$1,026.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,745.05
|
| Rate for Payer: Riverside University Health System MISP |
$821.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,231.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,231.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$770.49
|
| Rate for Payer: United Healthcare All Other HMO |
$749.96
|
| Rate for Payer: United Healthcare HMO Rider |
$733.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$672.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,745.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,745.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,745.05
|
|
|
HC EWHO FX OX WHO HINGE
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
905353985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$351.74 |
| Max. Negotiated Rate |
$1,475.88 |
| Rate for Payer: Adventist Health Commercial |
$440.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$805.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$630.76
|
| Rate for Payer: Blue Shield of California Commercial |
$830.20
|
| Rate for Payer: Blue Shield of California EPN |
$541.30
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Central Health Plan Commercial |
$859.20
|
| Rate for Payer: Cigna of CA HMO |
$751.80
|
| Rate for Payer: Cigna of CA PPO |
$751.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$912.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.60
|
| Rate for Payer: EPIC Health Plan Senior |
$429.60
|
| Rate for Payer: Galaxy Health WC |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$966.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,336.06
|
| Rate for Payer: InnovAge PACE Commercial |
$537.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$664.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$751.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$751.80
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: Networks By Design Commercial |
$537.00
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
| Rate for Payer: Riverside University Health System MISP |
$429.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$644.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$644.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$403.07
|
| Rate for Payer: United Healthcare All Other HMO |
$392.33
|
| Rate for Payer: United Healthcare HMO Rider |
$383.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$912.90
|
| Rate for Payer: Vantage Medical Group Senior |
$912.90
|
|
|
HC EWHO FX OX WHO HINGE
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
905353985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$214.80 |
| Max. Negotiated Rate |
$966.60 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Blue Shield of California Commercial |
$830.20
|
| Rate for Payer: Blue Shield of California EPN |
$541.30
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Central Health Plan Commercial |
$859.20
|
| Rate for Payer: Cigna of CA HMO |
$751.80
|
| Rate for Payer: Cigna of CA PPO |
$751.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.60
|
| Rate for Payer: EPIC Health Plan Senior |
$429.60
|
| Rate for Payer: Galaxy Health WC |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$966.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$664.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.80
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: Networks By Design Commercial |
$698.10
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$403.07
|
| Rate for Payer: United Healthcare All Other HMO |
$392.33
|
| Rate for Payer: United Healthcare HMO Rider |
$383.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.74
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
905353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,480.30
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.00
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$1,244.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
905353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$627.16 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,124.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,480.30
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.71
|
| Rate for Payer: InnovAge PACE Commercial |
$957.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$785.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Riverside University Health System MISP |
$766.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
915353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$627.16 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,124.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,480.30
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.71
|
| Rate for Payer: InnovAge PACE Commercial |
$957.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$785.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Riverside University Health System MISP |
$766.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
915353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,480.30
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.00
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$1,244.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
915353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Adventist Health Commercial |
$405.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,565.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,020.60
|
| Rate for Payer: Cash Price |
$1,113.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.00
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,822.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,253.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,518.75
|
| Rate for Payer: Networks By Design Commercial |
$1,316.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
IP
|
$2,095.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
905353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$419.00 |
| Max. Negotiated Rate |
$1,885.50 |
| Rate for Payer: Adventist Health Commercial |
$419.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,619.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,055.88
|
| Rate for Payer: Cash Price |
$1,152.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,676.00
|
| Rate for Payer: Cigna of CA HMO |
$1,466.50
|
| Rate for Payer: Cigna of CA PPO |
$1,466.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$838.00
|
| Rate for Payer: Galaxy Health WC |
$1,780.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,885.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,397.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$798.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,296.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.00
|
| Rate for Payer: Multiplan Commercial |
$1,571.25
|
| Rate for Payer: Networks By Design Commercial |
$1,361.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,780.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$786.25
|
| Rate for Payer: United Healthcare All Other HMO |
$765.30
|
| Rate for Payer: United Healthcare HMO Rider |
$748.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.11
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
OP
|
$2,025.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
915353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$663.19 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Adventist Health Commercial |
$830.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,113.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,518.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,189.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,565.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,020.60
|
| Rate for Payer: Cash Price |
$1,113.75
|
| Rate for Payer: Cash Price |
$1,113.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.00
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,721.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,721.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,822.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,336.06
|
| Rate for Payer: InnovAge PACE Commercial |
$1,012.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,253.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,417.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,417.50
|
| Rate for Payer: Multiplan Commercial |
$1,518.75
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: Riverside University Health System MISP |
$810.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,215.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,721.25
|
|
