|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
905355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$5,149.80 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,423.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,883.89
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,577.60
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,149.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,180.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,541.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.40
|
| Rate for Payer: Multiplan Commercial |
$4,291.50
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
915365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
915365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.62
|
| Rate for Payer: Blue Shield of California Commercial |
$95.32
|
| Rate for Payer: Blue Shield of California EPN |
$62.24
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.73
|
| Rate for Payer: InnovAge PACE Commercial |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Riverside University Health System MISP |
$62.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.00
|
| Rate for Payer: United Healthcare All Other HMO |
$78.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.60
|
| Rate for Payer: Vantage Medical Group Senior |
$132.60
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.46
|
| Rate for Payer: Blue Shield of California Commercial |
$83.71
|
| Rate for Payer: Blue Shield of California EPN |
$54.66
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Cigna of CA HMO |
$87.68
|
| Rate for Payer: Cigna of CA PPO |
$101.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.73
|
| Rate for Payer: InnovAge PACE Commercial |
$68.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Riverside University Health System MISP |
$54.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.50
|
| Rate for Payer: United Healthcare All Other HMO |
$68.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
915365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
905365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
915365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$33.33 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.33
|
| Rate for Payer: Blue Shield of California Commercial |
$166.80
|
| Rate for Payer: Blue Shield of California EPN |
$108.93
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: Cigna of CA HMO |
$174.72
|
| Rate for Payer: Cigna of CA PPO |
$202.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.33
|
| Rate for Payer: InnovAge PACE Commercial |
$136.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
| Rate for Payer: Riverside University Health System MISP |
$109.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.50
|
| Rate for Payer: United Healthcare All Other HMO |
$136.50
|
| Rate for Payer: United Healthcare HMO Rider |
$136.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.05
|
| Rate for Payer: Vantage Medical Group Senior |
$232.05
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
905365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$33.33 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.33
|
| Rate for Payer: Blue Shield of California Commercial |
$166.80
|
| Rate for Payer: Blue Shield of California EPN |
$108.93
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: Cigna of CA HMO |
$174.72
|
| Rate for Payer: Cigna of CA PPO |
$202.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.33
|
| Rate for Payer: InnovAge PACE Commercial |
$136.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
| Rate for Payer: Riverside University Health System MISP |
$109.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.50
|
| Rate for Payer: United Healthcare All Other HMO |
$136.50
|
| Rate for Payer: United Healthcare HMO Rider |
$136.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.05
|
| Rate for Payer: Vantage Medical Group Senior |
$232.05
|
|
|
HC MULTI FAMILY GROUP PSYCH
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
900100710
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC MULTI FAMILY GROUP PSYCH
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
900100710
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$58.27 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$204.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.67
|
| Rate for Payer: Blue Shield of California Commercial |
$295.11
|
| Rate for Payer: Blue Shield of California EPN |
$192.72
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Senior |
$204.15
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.15
|
| Rate for Payer: InnovAge PACE Commercial |
$306.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.56
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$204.15
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Prime Health Services Medicare |
$216.40
|
| Rate for Payer: Riverside University Health System MISP |
$224.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.50
|
| Rate for Payer: United Healthcare All Other HMO |
$241.50
|
| Rate for Payer: United Healthcare HMO Rider |
$241.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$204.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Vantage Medical Group Senior |
$204.15
|
|
|
HC MULTI FAMILY GROUP PSYCH
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
900100710
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC MULTI FAMILY GROUP PSYCH
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
900100710
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.27 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$204.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.67
|
| Rate for Payer: Blue Shield of California Commercial |
$295.11
|
| Rate for Payer: Blue Shield of California EPN |
$192.72
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Senior |
$204.15
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.15
|
| Rate for Payer: InnovAge PACE Commercial |
$306.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.56
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$204.15
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Prime Health Services Medicare |
$216.40
|
| Rate for Payer: Riverside University Health System MISP |
$224.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.50
|
| Rate for Payer: United Healthcare All Other HMO |
$241.50
|
| Rate for Payer: United Healthcare HMO Rider |
$241.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$204.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Vantage Medical Group Senior |
$204.15
|
|
|
HC MULTI FAMILY GRP BHVR MGMT MOD TRNG EA ADD 15 MIN
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 96203
|
| Hospital Charge Code |
907806203
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.48
|
| Rate for Payer: Blue Shield of California Commercial |
$34.83
|
| Rate for Payer: Blue Shield of California EPN |
$22.74
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: InnovAge PACE Commercial |
$28.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.90
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Riverside University Health System MISP |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$48.45
|
|
|
HC MULTI FAMILY GRP BHVR MGMT MOD TRNG EA ADD 15 MIN
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 96203
|
| Hospital Charge Code |
907806203
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.28
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
|
|
HC MULTI FAMILY GRP BHVR MGMT MOD TRNG INITIAL 60 MIN
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 96202
|
| Hospital Charge Code |
907806202
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$222.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.87
|
| Rate for Payer: Blue Shield of California Commercial |
$160.08
|
| Rate for Payer: Blue Shield of California EPN |
$104.54
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: Cigna of CA HMO |
$167.68
|
| Rate for Payer: Cigna of CA PPO |
$193.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$222.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$222.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$222.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: InnovAge PACE Commercial |
$131.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$183.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
| Rate for Payer: Riverside University Health System MISP |
$104.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.00
|
| Rate for Payer: United Healthcare All Other HMO |
$131.00
|
| Rate for Payer: United Healthcare HMO Rider |
$131.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$222.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$222.70
|
| Rate for Payer: Vantage Medical Group Senior |
$222.70
|
|
|
HC MULTI FAMILY GRP BHVR MGMT MOD TRNG INITIAL 60 MIN
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 96202
|
| Hospital Charge Code |
907806202
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.18
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
900009577
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.57
|
| Rate for Payer: Blue Shield of California Commercial |
$11.00
|
| Rate for Payer: Blue Shield of California EPN |
$7.18
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.81
|
| Rate for Payer: InnovAge PACE Commercial |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Riverside University Health System MISP |
$7.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
900009577
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13.91
|
| Rate for Payer: Blue Shield of California EPN |
$9.07
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC MULTI-PLANAR RECON
|
Facility
|
OP
|
$1,768.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$353.60 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$353.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,502.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$972.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,326.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$701.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,038.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,080.25
|
| Rate for Payer: Blue Shield of California EPN |
$705.43
|
| Rate for Payer: Cash Price |
$795.60
|
| Rate for Payer: Cash Price |
$795.60
|
| Rate for Payer: Cash Price |
$795.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,414.40
|
| Rate for Payer: Cigna of CA HMO |
$1,131.52
|
| Rate for Payer: Cigna of CA PPO |
$1,308.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,502.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,502.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,502.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$707.20
|
| Rate for Payer: EPIC Health Plan Senior |
$707.20
|
| Rate for Payer: Galaxy Health WC |
$1,502.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,060.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,591.20
|
| Rate for Payer: InnovAge PACE Commercial |
$884.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,179.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$673.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,094.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,237.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,237.60
|
| Rate for Payer: Multiplan Commercial |
$1,326.00
|
| Rate for Payer: Networks By Design Commercial |
$1,149.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,502.80
|
| Rate for Payer: Riverside University Health System MISP |
$707.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,060.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,060.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$884.00
|
| Rate for Payer: United Healthcare All Other HMO |
$884.00
|
| Rate for Payer: United Healthcare HMO Rider |
$884.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$884.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,502.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,502.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,502.80
|
|
|
HC MULTI-PLANAR RECON
|
Facility
|
IP
|
$1,768.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$353.60 |
| Max. Negotiated Rate |
$1,591.20 |
| Rate for Payer: Adventist Health Commercial |
$353.60
|
| Rate for Payer: Cash Price |
$795.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,414.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$707.20
|
| Rate for Payer: EPIC Health Plan Senior |
$707.20
|
| Rate for Payer: Galaxy Health WC |
$1,502.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,060.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,591.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,179.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$673.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,094.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.60
|
| Rate for Payer: Multiplan Commercial |
$1,326.00
|
| Rate for Payer: Networks By Design Commercial |
$1,149.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,502.80
|
|
|
HC MULTI-PODUS LINER
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT L4392
|
| Hospital Charge Code |
915354320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.58 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Adventist Health Commercial |
$99.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.71
|
| Rate for Payer: Blue Shield of California Commercial |
$187.84
|
| Rate for Payer: Blue Shield of California EPN |
$122.47
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Central Health Plan Commercial |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.70
|
| Rate for Payer: InnovAge PACE Commercial |
$121.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$182.25
|
| Rate for Payer: Networks By Design Commercial |
$121.50
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: Riverside University Health System MISP |
$97.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.55
|
| Rate for Payer: Vantage Medical Group Senior |
$206.55
|
|
|
HC MULTI-PODUS LINER
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT L4392
|
| Hospital Charge Code |
915354320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Blue Shield of California Commercial |
$187.84
|
| Rate for Payer: Blue Shield of California EPN |
$122.47
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Central Health Plan Commercial |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.60
|
| Rate for Payer: Multiplan Commercial |
$182.25
|
| Rate for Payer: Networks By Design Commercial |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
|
|
HC MULTI-PODUS LINER
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT L4392
|
| Hospital Charge Code |
905354320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.58 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Adventist Health Commercial |
$99.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.71
|
| Rate for Payer: Blue Shield of California Commercial |
$187.84
|
| Rate for Payer: Blue Shield of California EPN |
$122.47
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Central Health Plan Commercial |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.70
|
| Rate for Payer: InnovAge PACE Commercial |
$121.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$182.25
|
| Rate for Payer: Networks By Design Commercial |
$121.50
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: Riverside University Health System MISP |
$97.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.55
|
| Rate for Payer: Vantage Medical Group Senior |
$206.55
|
|
|
HC MULTI-PODUS LINER
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT L4392
|
| Hospital Charge Code |
905354320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Blue Shield of California Commercial |
$187.84
|
| Rate for Payer: Blue Shield of California EPN |
$122.47
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Central Health Plan Commercial |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.60
|
| Rate for Payer: Multiplan Commercial |
$182.25
|
| Rate for Payer: Networks By Design Commercial |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
|
