|
HC ELECT STIM UNATTENDED/ULCERS OT
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
905104524
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$70.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: Dignity Health Media |
$100.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$88.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.38
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Riverside University Health System MISP |
$47.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.30
|
| Rate for Payer: Vantage Medical Group Senior |
$100.30
|
|
|
HC ELECT STIM UNATTENDED/ULCERS PT
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
905103507
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$70.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: Dignity Health Media |
$100.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$88.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.38
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Riverside University Health System MISP |
$47.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.30
|
| Rate for Payer: Vantage Medical Group Senior |
$100.30
|
|
|
HC ELECT STIM UNATTENDED/ULCERS PT
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
905103507
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
|
|
HC ELECT STIM UNATTENDED/ULCERS PT COMM MCARE
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
900419077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
|
|
HC ELECT STIM UNATTENDED/ULCERS PT COMM MCARE
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
900419077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$70.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: Dignity Health Media |
$100.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$88.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.38
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Riverside University Health System MISP |
$47.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.30
|
| Rate for Payer: Vantage Medical Group Senior |
$100.30
|
|
|
HC ELECT STIM UNATTEND WOUND CARE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
905103508
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$75.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.25
|
| Rate for Payer: Dignity Health Media |
$106.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$93.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Riverside University Health System MISP |
$50.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
|
|
HC ELECT STIM UNATTEND WOUND CARE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
905103508
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC ELECT STIM UNATTEND WOUND CARE COMM MCARE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900419078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC ELECT STIM UNATTEND WOUND CARE COMM MCARE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900419078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$75.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.25
|
| Rate for Payer: Dignity Health Media |
$106.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$93.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Riverside University Health System MISP |
$50.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$75.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.25
|
| Rate for Payer: Dignity Health Media |
$106.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$93.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Riverside University Health System MISP |
$50.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
|
|
HC ELECT WRIST ROTAT UTAH AREM
|
Facility
|
IP
|
$12,730.00
|
|
|
Service Code
|
CPT L7259
|
| Hospital Charge Code |
905357261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,546.00 |
| Max. Negotiated Rate |
$11,457.00 |
| Rate for Payer: Blue Shield of California EPN |
$6,797.82
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,184.00
|
| Rate for Payer: Cigna of CA HMO |
$8,911.00
|
| Rate for Payer: Cigna of CA PPO |
$8,911.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,457.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,490.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,850.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,546.00
|
| Rate for Payer: Multiplan Commercial |
$9,547.50
|
| Rate for Payer: Networks By Design Commercial |
$6,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,806.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4,694.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4,592.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,200.90
|
|
|
HC ELECT WRIST ROTAT UTAH AREM
|
Facility
|
OP
|
$12,730.00
|
|
|
Service Code
|
CPT L7259
|
| Hospital Charge Code |
905357261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,455.50 |
| Max. Negotiated Rate |
$11,457.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,001.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,001.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,163.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,520.88
|
| Rate for Payer: Blue Distinction Transplant |
$7,638.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,547.50
|
| Rate for Payer: Blue Shield of California EPN |
$6,925.12
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,184.00
|
| Rate for Payer: Cigna of CA HMO |
$8,911.00
|
| Rate for Payer: Cigna of CA PPO |
$8,911.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Dignity Health Media |
$10,820.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,820.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,457.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,547.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,455.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,490.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,219.30
|
| Rate for Payer: Multiplan Commercial |
$9,547.50
|
| Rate for Payer: Networks By Design Commercial |
$6,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: Riverside University Health System MISP |
$5,092.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,365.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,365.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,365.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,365.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,820.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,820.50
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
|
OP
|
$6,747.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,389.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,048.20
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$3,036.15
|
| Rate for Payer: Cash Price |
$3,036.15
|
| Rate for Payer: Cash Price |
$3,036.15
|
| Rate for Payer: Cash Price |
$3,036.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,397.60
|
| Rate for Payer: Cigna of CA PPO |
$4,992.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$5,734.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,048.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,072.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,060.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: InnovAge PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,500.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,273.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,349.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$5,060.25
|
| Rate for Payer: Networks By Design Commercial |
$4,385.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,734.95
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,048.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,373.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,373.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,373.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,373.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
|
IP
|
$6,747.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,349.40 |
| Max. Negotiated Rate |
$6,072.30 |
| Rate for Payer: Cash Price |
$3,036.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,397.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,698.80
|
| Rate for Payer: Galaxy Health WC |
$5,734.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,048.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,072.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,500.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,570.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,349.40
|
| Rate for Payer: Multiplan Commercial |
$5,060.25
|
| Rate for Payer: Networks By Design Commercial |
$4,385.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,734.95
|
|
|
HC EMBOLIC ONYX
|
Facility
|
IP
|
$6,000.00
|
|
| Hospital Charge Code |
909081019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$5,400.00 |
| Rate for Payer: Blue Shield of California EPN |
$3,204.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,800.00
|
| Rate for Payer: Cigna of CA HMO |
$4,200.00
|
| Rate for Payer: Cigna of CA PPO |
$4,200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,400.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,400.00
|
| Rate for Payer: Galaxy Health WC |
$5,100.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,400.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,002.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,286.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,265.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2,212.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2,164.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,980.00
|
|
|
HC EMBOLIC ONYX
|
Facility
|
OP
|
$6,000.00
|
|
| Hospital Charge Code |
909081019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$5,400.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,300.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,300.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,739.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,342.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,600.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,500.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,264.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,800.00
|
| Rate for Payer: Cigna of CA HMO |
$4,200.00
|
| Rate for Payer: Cigna of CA PPO |
$4,200.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Dignity Health Media |
$5,100.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,400.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,400.00
|
| Rate for Payer: Galaxy Health WC |
$5,100.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,400.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,500.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,100.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,002.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,286.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: Networks By Design Commercial |
$3,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,100.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,400.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,600.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,000.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,000.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,100.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,100.00
|
|
|
HC EMBOLIZATION COILS .018
|
Facility
|
OP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$322.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$196.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.41
|
| Rate for Payer: Blue Distinction Transplant |
$214.80
|
| Rate for Payer: Blue Shield of California Commercial |
$268.50
|
| Rate for Payer: Blue Shield of California EPN |
$194.75
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Central Health Plan Commercial |
$286.40
|
| Rate for Payer: Cigna of CA HMO |
$250.60
|
| Rate for Payer: Cigna of CA PPO |
$250.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$304.30
|
| Rate for Payer: Dignity Health Media |
$304.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$304.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$143.20
|
| Rate for Payer: Galaxy Health WC |
$304.30
|
| Rate for Payer: Global Benefits Group Commercial |
$214.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$322.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$268.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.60
|
| Rate for Payer: Multiplan Commercial |
$268.50
|
| Rate for Payer: Networks By Design Commercial |
$179.00
|
| Rate for Payer: Prime Health Services Commercial |
$304.30
|
| Rate for Payer: Riverside University Health System MISP |
$143.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$214.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.00
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$179.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$179.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$304.30
|
| Rate for Payer: Vantage Medical Group Senior |
$304.30
|
|
|
HC EMBOLIZATION COILS .018
|
Facility
|
IP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$322.20 |
| Rate for Payer: Blue Shield of California EPN |
$191.17
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Central Health Plan Commercial |
$286.40
|
| Rate for Payer: Cigna of CA HMO |
$250.60
|
| Rate for Payer: Cigna of CA PPO |
$250.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$143.20
|
| Rate for Payer: Galaxy Health WC |
$304.30
|
| Rate for Payer: Global Benefits Group Commercial |
$214.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$322.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.60
|
| Rate for Payer: Multiplan Commercial |
$268.50
|
| Rate for Payer: Prime Health Services Commercial |
$304.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.18
|
| Rate for Payer: United Healthcare All Other HMO |
$132.03
|
| Rate for Payer: United Healthcare HMO Rider |
$129.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.14
|
|
|
HC EMBOLIZATION DEVICE PIPELINE
|
Facility
|
OP
|
$25,000.00
|
|
| Hospital Charge Code |
909020126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15,182.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,770.00
|
| Rate for Payer: Blue Distinction Transplant |
$15,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15,725.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,225.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$16,000.00
|
| Rate for Payer: Cigna of CA PPO |
$18,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Media |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,750.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,500.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,500.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,500.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC EMBOLIZATION DEVICE PIPELINE
|
Facility
|
IP
|
$25,000.00
|
|
| Hospital Charge Code |
909020126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
OP
|
$33,470.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.49 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,417.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,791.68
|
| Rate for Payer: Blue Distinction Transplant |
$20,082.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$15,061.50
|
| Rate for Payer: Cash Price |
$15,061.50
|
| Rate for Payer: Central Health Plan Commercial |
$26,776.00
|
| Rate for Payer: Cigna of CA PPO |
$24,767.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$28,449.50
|
| Rate for Payer: Global Benefits Group Commercial |
$20,082.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,123.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25,102.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,679.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: InnovAge PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,324.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,694.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$25,102.50
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$21,755.50
|
| Rate for Payer: Preferred Health Network WC |
$19,175.18
|
| Rate for Payer: Prime Health Services Commercial |
$28,449.50
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Riverside University Health System MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,082.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
IP
|
$33,470.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,694.00 |
| Max. Negotiated Rate |
$30,123.00 |
| Rate for Payer: Cash Price |
$15,061.50
|
| Rate for Payer: Central Health Plan Commercial |
$26,776.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,388.00
|
| Rate for Payer: Galaxy Health WC |
$28,449.50
|
| Rate for Payer: Global Benefits Group Commercial |
$20,082.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,324.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,752.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,694.00
|
| Rate for Payer: Multiplan Commercial |
$25,102.50
|
| Rate for Payer: Networks By Design Commercial |
$21,755.50
|
| Rate for Payer: Prime Health Services Commercial |
$28,449.50
|
|
|
HC EMBOLIZATION FOAM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
909081259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Blue Shield of California EPN |
$186.90
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.16
|
| Rate for Payer: United Healthcare All Other HMO |
$129.08
|
| Rate for Payer: United Healthcare HMO Rider |
$126.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.50
|
|
|
HC EMBOLIZATION FOAM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
909081259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$159.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$194.95
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.50
|
| Rate for Payer: Blue Shield of California EPN |
$190.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
