|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
OP
|
$5,013.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
906820288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.30 |
| Max. Negotiated Rate |
$13,979.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,338.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,757.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,757.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,007.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,010.40
|
| Rate for Payer: Cigna of CA PPO |
$3,709.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Dignity Health Media |
$4,261.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,261.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,005.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,005.20
|
| Rate for Payer: Galaxy Health WC |
$4,261.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,511.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,759.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,754.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.60
|
| Rate for Payer: Multiplan Commercial |
$3,759.75
|
| Rate for Payer: Networks By Design Commercial |
$3,258.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,261.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,005.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,007.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,261.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,261.05
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
IP
|
$5,013.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
909033894
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,002.60 |
| Max. Negotiated Rate |
$4,511.70 |
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,010.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,005.20
|
| Rate for Payer: Galaxy Health WC |
$4,261.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,511.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,909.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.60
|
| Rate for Payer: Multiplan Commercial |
$3,759.75
|
| Rate for Payer: Networks By Design Commercial |
$3,258.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,261.05
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
OP
|
$5,013.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
909033894
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.30 |
| Max. Negotiated Rate |
$13,979.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,338.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,757.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,757.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,007.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,010.40
|
| Rate for Payer: Cigna of CA PPO |
$3,709.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Dignity Health Media |
$4,261.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,261.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,005.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,005.20
|
| Rate for Payer: Galaxy Health WC |
$4,261.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,511.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,759.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,754.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.60
|
| Rate for Payer: Multiplan Commercial |
$3,759.75
|
| Rate for Payer: Networks By Design Commercial |
$3,258.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,261.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,005.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,007.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,261.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,261.05
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
OP
|
$5,013.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
909033895
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,002.60 |
| Max. Negotiated Rate |
$13,979.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,247.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,757.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,757.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,007.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,010.40
|
| Rate for Payer: Cigna of CA PPO |
$3,709.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Dignity Health Media |
$4,261.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,261.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,005.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,005.20
|
| Rate for Payer: Galaxy Health WC |
$4,261.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,511.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,759.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,754.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,220.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.60
|
| Rate for Payer: Multiplan Commercial |
$3,759.75
|
| Rate for Payer: Networks By Design Commercial |
$3,258.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,261.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,005.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,007.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,261.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,261.05
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
IP
|
$5,013.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
909033895
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,002.60 |
| Max. Negotiated Rate |
$4,511.70 |
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,010.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,005.20
|
| Rate for Payer: Galaxy Health WC |
$4,261.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,511.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,909.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.60
|
| Rate for Payer: Multiplan Commercial |
$3,759.75
|
| Rate for Payer: Networks By Design Commercial |
$3,258.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,261.05
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
OP
|
$5,013.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
906820289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,002.60 |
| Max. Negotiated Rate |
$13,979.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,247.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,757.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,757.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,007.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,010.40
|
| Rate for Payer: Cigna of CA PPO |
$3,709.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Dignity Health Media |
$4,261.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,261.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,005.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,005.20
|
| Rate for Payer: Galaxy Health WC |
$4,261.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,511.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,759.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,754.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,220.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.60
|
| Rate for Payer: Multiplan Commercial |
$3,759.75
|
| Rate for Payer: Networks By Design Commercial |
$3,258.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,261.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,005.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,007.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,261.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,261.05
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
IP
|
$5,013.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
906820289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,002.60 |
| Max. Negotiated Rate |
$4,511.70 |
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,010.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,005.20
|
| Rate for Payer: Galaxy Health WC |
$4,261.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,511.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,909.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.60
|
| Rate for Payer: Multiplan Commercial |
$3,759.75
|
| Rate for Payer: Networks By Design Commercial |
$3,258.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,261.05
|
|
|
HC EV FEM POP ARTERIAL REVASC
|
Facility
|
OP
|
$30,560.00
|
|
|
Service Code
|
CPT 0505T
|
| Hospital Charge Code |
909000505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| 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 |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,791.68
|
| Rate for Payer: Blue Distinction Transplant |
$18,336.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$13,752.00
|
| Rate for Payer: Cash Price |
$13,752.00
|
| Rate for Payer: Central Health Plan Commercial |
$24,448.00
|
| Rate for Payer: Cigna of CA PPO |
$22,614.40
|
| 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 |
$25,976.00
|
| Rate for Payer: Global Benefits Group Commercial |
$18,336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,504.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22,920.00
|
| 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 |
$20,383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,643.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,112.00
|
| 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 |
$22,920.00
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$19,864.00
|
| Rate for Payer: Preferred Health Network WC |
$19,175.18
|
| Rate for Payer: Prime Health Services Commercial |
$25,976.00
|
| 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 |
$18,336.00
|
| 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 EV FEM POP ARTERIAL REVASC
|
Facility
|
IP
|
$30,560.00
|
|
|
Service Code
|
CPT 0505T
|
| Hospital Charge Code |
909000505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,112.00 |
| Max. Negotiated Rate |
$27,504.00 |
| Rate for Payer: Cash Price |
$13,752.00
|
| Rate for Payer: Central Health Plan Commercial |
$24,448.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,224.00
|
| Rate for Payer: Galaxy Health WC |
$25,976.00
|
| Rate for Payer: Global Benefits Group Commercial |
$18,336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,643.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,112.00
|
| Rate for Payer: Multiplan Commercial |
$22,920.00
|
| Rate for Payer: Networks By Design Commercial |
$19,864.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,976.00
|
|
|
HC EVL/TRTMT MH OR SUB USE DISORDER REMOTE 15-29 MIN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT C7900
|
| Hospital Charge Code |
907807900
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.40
|
| Rate for Payer: Blue Distinction Transplant |
$52.20
|
| Rate for Payer: Blue Shield of California Commercial |
$54.72
|
| Rate for Payer: Blue Shield of California EPN |
$42.54
|
| Rate for Payer: Caremore Medicare Advantage |
$35.85
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: Cigna of CA HMO |
$55.68
|
| Rate for Payer: Cigna of CA PPO |
$64.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.78
|
| Rate for Payer: Dignity Health Media |
$35.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.85
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$65.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$58.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.85
|
| Rate for Payer: InnovAge PACE Commercial |
$53.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.04
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Prime Health Services Medicare |
$38.00
|
| Rate for Payer: Riverside University Health System MISP |
$39.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.50
|
| Rate for Payer: United Healthcare All Other HMO |
$43.50
|
| Rate for Payer: United Healthcare HMO Rider |
$43.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Vantage Medical Group Senior |
$35.85
|
|
|
HC EVL/TRTMT MH OR SUB USE DISORDER REMOTE 15-29 MIN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT C7900
|
| Hospital Charge Code |
907807900
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC EVL/TRTMT MH OR SUB USE DISORDER REMOTE 30-60 MIN
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT C7901
|
| Hospital Charge Code |
907807901
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
|
|
HC EVL/TRTMT MH OR SUB USE DISORDER REMOTE 30-60 MIN
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT C7901
|
| Hospital Charge Code |
907807901
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.16
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| Rate for Payer: Blue Shield of California Commercial |
$139.64
|
| Rate for Payer: Blue Shield of California EPN |
$108.56
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.00
|
| Rate for Payer: United Healthcare All Other HMO |
$111.00
|
| Rate for Payer: United Healthcare HMO Rider |
$111.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC EVL/TRTMT MH OR SUB USE DISORDER REMOTE EA ADD 15 MIN
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT C7902
|
| Hospital Charge Code |
907807902
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$94.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.58
|
| Rate for Payer: Blue Distinction Transplant |
$66.60
|
| Rate for Payer: Blue Shield of California Commercial |
$69.82
|
| Rate for Payer: Blue Shield of California EPN |
$54.28
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Central Health Plan Commercial |
$88.80
|
| Rate for Payer: Cigna of CA HMO |
$71.04
|
| Rate for Payer: Cigna of CA PPO |
$82.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.35
|
| Rate for Payer: Dignity Health Media |
$94.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$94.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.40
|
| Rate for Payer: Galaxy Health WC |
$94.35
|
| Rate for Payer: Global Benefits Group Commercial |
$66.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$83.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.20
|
| Rate for Payer: Multiplan Commercial |
$83.25
|
| Rate for Payer: Networks By Design Commercial |
$72.15
|
| Rate for Payer: Prime Health Services Commercial |
$94.35
|
| Rate for Payer: Riverside University Health System MISP |
$44.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.50
|
| Rate for Payer: United Healthcare All Other HMO |
$55.50
|
| Rate for Payer: United Healthcare HMO Rider |
$55.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$94.35
|
| Rate for Payer: Vantage Medical Group Senior |
$94.35
|
|
|
HC EVL/TRTMT MH OR SUB USE DISORDER REMOTE EA ADD 15 MIN
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT C7902
|
| Hospital Charge Code |
907807902
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Central Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.40
|
| Rate for Payer: Galaxy Health WC |
$94.35
|
| Rate for Payer: Global Benefits Group Commercial |
$66.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.20
|
| Rate for Payer: Multiplan Commercial |
$83.25
|
| Rate for Payer: Networks By Design Commercial |
$72.15
|
| Rate for Payer: Prime Health Services Commercial |
$94.35
|
|
|
HC EV VEN ATLIZTN TBL OR PRL VEIN
|
Facility
|
IP
|
$49,545.00
|
|
|
Service Code
|
CPT 0620T
|
| Hospital Charge Code |
909000620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,909.00 |
| Max. Negotiated Rate |
$44,590.50 |
| Rate for Payer: Cash Price |
$22,295.25
|
| Rate for Payer: Central Health Plan Commercial |
$39,636.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,818.00
|
| Rate for Payer: Galaxy Health WC |
$42,113.25
|
| Rate for Payer: Global Benefits Group Commercial |
$29,727.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$44,590.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,876.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,909.00
|
| Rate for Payer: Multiplan Commercial |
$37,158.75
|
| Rate for Payer: Networks By Design Commercial |
$32,204.25
|
| Rate for Payer: Prime Health Services Commercial |
$42,113.25
|
|
|
HC EV VEN ATLIZTN TBL OR PRL VEIN
|
Facility
|
OP
|
$49,545.00
|
|
|
Service Code
|
CPT 0620T
|
| Hospital Charge Code |
909000620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$59,503.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$36,062.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54,093.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39,668.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,062.51
|
| 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 |
$31,747.68
|
| Rate for Payer: Blue Distinction Transplant |
$29,727.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$36,062.51
|
| Rate for Payer: Cash Price |
$22,295.25
|
| Rate for Payer: Cash Price |
$22,295.25
|
| Rate for Payer: Central Health Plan Commercial |
$39,636.00
|
| Rate for Payer: Cigna of CA PPO |
$36,663.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54,093.76
|
| Rate for Payer: Dignity Health Media |
$36,062.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$39,668.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,684.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36,062.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$36,062.51
|
| Rate for Payer: Galaxy Health WC |
$42,113.25
|
| Rate for Payer: Global Benefits Group Commercial |
$29,727.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$44,590.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37,158.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$59,142.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59,503.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,062.51
|
| Rate for Payer: InnovAge PACE Commercial |
$54,093.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,876.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,062.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,909.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,323.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,323.76
|
| Rate for Payer: Multiplan Commercial |
$37,158.75
|
| Rate for Payer: Multiplan WC |
$31,747.68
|
| Rate for Payer: Networks By Design Commercial |
$32,204.25
|
| Rate for Payer: Preferred Health Network WC |
$32,395.59
|
| Rate for Payer: Prime Health Services Commercial |
$42,113.25
|
| Rate for Payer: Prime Health Services Medicare |
$38,226.26
|
| Rate for Payer: Prime Health Services WC |
$31,423.72
|
| Rate for Payer: Riverside University Health System MISP |
$39,668.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,727.00
|
| 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 |
$54,093.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,668.76
|
| Rate for Payer: Vantage Medical Group Senior |
$36,062.51
|
|
|
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: Blue Shield of California EPN |
$1,022.61
|
| Rate for Payer: Cash Price |
$861.75
|
| 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 Transplant |
$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 |
$1,277.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.62
|
| 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 |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$723.10
|
| Rate for Payer: United Healthcare All Other HMO |
$706.25
|
| Rate for Payer: United Healthcare HMO Rider |
$690.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$631.95
|
|
|
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 |
$670.25 |
| Max. Negotiated Rate |
$1,723.50 |
| 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 |
$1,053.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$927.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,131.38
|
| Rate for Payer: Blue Distinction Transplant |
$1,149.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,436.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,041.76
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| 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 Media |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,436.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$670.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$785.15
|
| 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 |
$957.50
|
| Rate for Payer: United Healthcare All Other HMO |
$957.50
|
| Rate for Payer: United Healthcare HMO Rider |
$957.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
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: Blue Shield of California EPN |
$1,081.35
|
| Rate for Payer: Cash Price |
$911.25
|
| 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 Transplant |
$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 |
$1,350.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.52
|
| 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 |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.64
|
| Rate for Payer: United Healthcare All Other HMO |
$746.82
|
| Rate for Payer: United Healthcare HMO Rider |
$730.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$668.25
|
|
|
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 |
$708.75 |
| Max. Negotiated Rate |
$1,822.50 |
| 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 |
$1,113.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$980.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,196.37
|
| Rate for Payer: Blue Distinction Transplant |
$1,215.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,518.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,101.60
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| 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 Media |
$1,721.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,721.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,518.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$708.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,475.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| 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 |
$1,012.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,012.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,012.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,012.50
|
| 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
|
OP
|
$396.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
903203986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$1,393.74 |
| 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 |
$217.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$191.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.96
|
| Rate for Payer: Blue Distinction Transplant |
$237.60
|
| Rate for Payer: Blue Shield of California Commercial |
$297.00
|
| Rate for Payer: Blue Shield of California EPN |
$215.42
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| 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 Media |
$336.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$297.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$138.60
|
| 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: LLUH Dept of Risk Management WC |
$162.36
|
| 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 |
$198.00
|
| Rate for Payer: United Healthcare All Other HMO |
$198.00
|
| Rate for Payer: United Healthcare HMO Rider |
$198.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.60
|
| Rate for Payer: Vantage Medical Group Senior |
$336.60
|
|
|
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: Blue Shield of California EPN |
$211.46
|
| Rate for Payer: Cash Price |
$178.20
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$79.20
|
| 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: United Healthcare All Other Commercial |
$149.53
|
| Rate for Payer: United Healthcare All Other HMO |
$146.04
|
| Rate for Payer: United Healthcare HMO Rider |
$142.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.68
|
|
|
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: Blue Shield of California EPN |
$1,022.61
|
| Rate for Payer: Cash Price |
$861.75
|
| 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 Transplant |
$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 |
$1,277.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.62
|
| 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 |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$723.10
|
| Rate for Payer: United Healthcare All Other HMO |
$706.25
|
| Rate for Payer: United Healthcare HMO Rider |
$690.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$631.95
|
|
|
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 |
$670.25 |
| Max. Negotiated Rate |
$1,723.50 |
| 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 |
$1,053.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$927.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,131.38
|
| Rate for Payer: Blue Distinction Transplant |
$1,149.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,436.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,041.76
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| 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 Media |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,436.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$670.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$785.15
|
| 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 |
$957.50
|
| Rate for Payer: United Healthcare All Other HMO |
$957.50
|
| Rate for Payer: United Healthcare HMO Rider |
$957.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
