|
HC PSYCH TESTING
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 96100
|
| Hospital Charge Code |
907804040
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.09
|
| Rate for Payer: Blue Shield of California Commercial |
$91.65
|
| Rate for Payer: Blue Shield of California EPN |
$59.85
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: InnovAge PACE Commercial |
$75.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Riverside University Health System MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.00
|
| Rate for Payer: United Healthcare All Other HMO |
$75.00
|
| Rate for Payer: United Healthcare HMO Rider |
$75.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC PTA FEM/POP
|
Facility
|
OP
|
$13,017.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
909020065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$669.82 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,603.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,244.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,542.58
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Central Health Plan Commercial |
$10,413.60
|
| Rate for Payer: Cigna of CA HMO |
$8,330.88
|
| Rate for Payer: Cigna of CA PPO |
$9,632.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$11,064.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,810.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,715.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$669.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,866.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,682.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$739.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,603.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,707.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$9,762.75
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$8,461.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Preferred Health Network WC |
$11,778.14
|
| Rate for Payer: Prime Health Services Commercial |
$11,064.45
|
| Rate for Payer: Prime Health Services Medicare |
$7,679.01
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Riverside University Health System MISP |
$7,968.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,810.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PTA FEM/POP
|
Facility
|
IP
|
$13,017.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
909020065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,603.40 |
| Max. Negotiated Rate |
$11,715.30 |
| Rate for Payer: Adventist Health Commercial |
$2,603.40
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Central Health Plan Commercial |
$10,413.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,206.80
|
| Rate for Payer: Galaxy Health WC |
$11,064.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,810.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,715.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,682.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,959.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,057.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,603.40
|
| Rate for Payer: Multiplan Commercial |
$9,762.75
|
| Rate for Payer: Networks By Design Commercial |
$8,461.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,064.45
|
|
|
HC PTA FEM/POP
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
906820148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,062.80 |
| Max. Negotiated Rate |
$13,782.60 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,782.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,479.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.80
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC PTA FEM/POP
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
906820148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$669.82 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,244.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,542.58
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,251.20
|
| Rate for Payer: Cigna of CA HMO |
$9,800.96
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,782.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$669.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,866.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$739.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,707.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Preferred Health Network WC |
$11,778.14
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Prime Health Services Medicare |
$7,679.01
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Riverside University Health System MISP |
$7,968.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PTA ILIAC
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
906820144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$607.69 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,244.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,542.58
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,251.20
|
| Rate for Payer: Cigna of CA HMO |
$9,800.96
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,782.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$607.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,866.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$671.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,707.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Preferred Health Network WC |
$11,778.14
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Prime Health Services Medicare |
$7,679.01
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Riverside University Health System MISP |
$7,968.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PTA ILIAC
|
Facility
|
OP
|
$13,017.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$607.69 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,603.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,244.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,542.58
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Central Health Plan Commercial |
$10,413.60
|
| Rate for Payer: Cigna of CA HMO |
$8,330.88
|
| Rate for Payer: Cigna of CA PPO |
$9,632.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$11,064.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,810.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,715.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$607.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,866.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,682.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$671.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,603.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,707.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$9,762.75
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$8,461.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Preferred Health Network WC |
$11,778.14
|
| Rate for Payer: Prime Health Services Commercial |
$11,064.45
|
| Rate for Payer: Prime Health Services Medicare |
$7,679.01
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Riverside University Health System MISP |
$7,968.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,810.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PTA ILIAC
|
Facility
|
IP
|
$13,017.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,603.40 |
| Max. Negotiated Rate |
$11,715.30 |
| Rate for Payer: Adventist Health Commercial |
$2,603.40
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Central Health Plan Commercial |
$10,413.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,206.80
|
| Rate for Payer: Galaxy Health WC |
$11,064.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,810.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,715.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,682.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,959.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,057.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,603.40
|
| Rate for Payer: Multiplan Commercial |
$9,762.75
|
| Rate for Payer: Networks By Design Commercial |
$8,461.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,064.45
|
|
|
HC PTA ILIAC
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
906820144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,062.80 |
| Max. Negotiated Rate |
$13,782.60 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,782.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,479.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.80
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
OP
|
$14,548.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
906820146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$275.99 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,001.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,911.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$6,546.60
|
| Rate for Payer: Cash Price |
$6,546.60
|
| Rate for Payer: Cash Price |
$6,546.60
|
| Rate for Payer: Central Health Plan Commercial |
$11,638.40
|
| Rate for Payer: Cigna of CA HMO |
$9,310.72
|
| Rate for Payer: Cigna of CA PPO |
$10,765.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,365.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,365.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,819.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,819.20
|
| Rate for Payer: Galaxy Health WC |
$12,365.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,728.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,093.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$275.99
|
| Rate for Payer: InnovAge PACE Commercial |
$7,274.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,703.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,005.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,909.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,183.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,183.60
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
| Rate for Payer: Networks By Design Commercial |
$9,456.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,365.80
|
| Rate for Payer: Riverside University Health System MISP |
$5,819.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,728.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,365.80
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
IP
|
$14,548.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
906820146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,909.60 |
| Max. Negotiated Rate |
$13,093.20 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Cash Price |
$6,546.60
|
| Rate for Payer: Central Health Plan Commercial |
$11,638.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,819.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,819.20
|
| Rate for Payer: Galaxy Health WC |
$12,365.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,728.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,093.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,703.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,542.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,005.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,909.60
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
| Rate for Payer: Networks By Design Commercial |
$9,456.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,365.80
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
OP
|
$12,366.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$275.99 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,801.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,274.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,892.80
|
| Rate for Payer: Cigna of CA HMO |
$7,914.24
|
| Rate for Payer: Cigna of CA PPO |
$9,150.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,511.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,511.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.40
|
| Rate for Payer: Galaxy Health WC |
$10,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,129.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$275.99
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,248.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,654.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,656.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,656.20
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: Networks By Design Commercial |
$8,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,511.10
|
| Rate for Payer: Riverside University Health System MISP |
$4,946.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,419.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,511.10
|
| Rate for Payer: Vantage Medical Group Senior |
$10,511.10
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
IP
|
$12,366.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,473.20 |
| Max. Negotiated Rate |
$11,129.40 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,892.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.40
|
| Rate for Payer: Galaxy Health WC |
$10,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,129.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,248.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,711.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,654.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.20
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: Networks By Design Commercial |
$8,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,511.10
|
|
|
HC PTA INTRACRAN VASO EA ADD DIFF
|
Facility
|
IP
|
$10,933.00
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
909081017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,186.60 |
| Max. Negotiated Rate |
$9,839.70 |
| Rate for Payer: Adventist Health Commercial |
$2,186.60
|
| Rate for Payer: Cash Price |
$4,919.85
|
| Rate for Payer: Central Health Plan Commercial |
$8,746.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,373.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,373.20
|
| Rate for Payer: Galaxy Health WC |
$9,293.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,559.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,839.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,292.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,165.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,767.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,186.60
|
| Rate for Payer: Multiplan Commercial |
$8,199.75
|
| Rate for Payer: Networks By Design Commercial |
$7,106.45
|
| Rate for Payer: Prime Health Services Commercial |
$9,293.05
|
|
|
HC PTA INTRACRAN VASO EA ADD DIFF
|
Facility
|
OP
|
$10,933.00
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
909081017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,186.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,186.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,293.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,013.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,199.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,293.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,420.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,919.85
|
| Rate for Payer: Cash Price |
$4,919.85
|
| Rate for Payer: Central Health Plan Commercial |
$8,746.40
|
| Rate for Payer: Cigna of CA HMO |
$6,997.12
|
| Rate for Payer: Cigna of CA PPO |
$8,090.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,293.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,293.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,293.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,373.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,373.20
|
| Rate for Payer: Galaxy Health WC |
$9,293.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,559.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,839.70
|
| Rate for Payer: InnovAge PACE Commercial |
$5,466.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,292.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,767.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,186.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,653.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,653.10
|
| Rate for Payer: Multiplan Commercial |
$8,199.75
|
| Rate for Payer: Networks By Design Commercial |
$7,106.45
|
| Rate for Payer: Prime Health Services Commercial |
$9,293.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,373.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,559.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,293.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,293.05
|
| Rate for Payer: Vantage Medical Group Senior |
$9,293.05
|
|
|
HC PTA INTRACRAN VASOPAMS EA ADDL
|
Facility
|
IP
|
$12,259.00
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
909081016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,451.80 |
| Max. Negotiated Rate |
$11,033.10 |
| Rate for Payer: Adventist Health Commercial |
$2,451.80
|
| Rate for Payer: Cash Price |
$5,516.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,807.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,903.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,903.60
|
| Rate for Payer: Galaxy Health WC |
$10,420.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,355.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,033.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,670.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,588.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,451.80
|
| Rate for Payer: Multiplan Commercial |
$9,194.25
|
| Rate for Payer: Networks By Design Commercial |
$7,968.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,420.15
|
|
|
HC PTA INTRACRAN VASOPAMS EA ADDL
|
Facility
|
OP
|
$12,259.00
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
909081016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,374.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,451.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,420.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,742.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,194.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,935.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,199.71
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,516.55
|
| Rate for Payer: Cash Price |
$5,516.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,807.20
|
| Rate for Payer: Cigna of CA HMO |
$7,845.76
|
| Rate for Payer: Cigna of CA PPO |
$9,071.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,420.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,420.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,420.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,903.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,903.60
|
| Rate for Payer: Galaxy Health WC |
$10,420.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,355.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,033.10
|
| Rate for Payer: InnovAge PACE Commercial |
$6,129.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,176.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,588.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,451.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,581.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,581.30
|
| Rate for Payer: Multiplan Commercial |
$9,194.25
|
| Rate for Payer: Networks By Design Commercial |
$7,968.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,420.15
|
| Rate for Payer: Riverside University Health System MISP |
$4,903.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,355.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,420.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,420.15
|
| Rate for Payer: Vantage Medical Group Senior |
$10,420.15
|
|
|
HC PTA INTRACRAN VASOSPASM
|
Facility
|
OP
|
$24,475.00
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
909081015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,374.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,895.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,803.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,461.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,356.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,850.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,374.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$11,013.75
|
| Rate for Payer: Cash Price |
$11,013.75
|
| Rate for Payer: Central Health Plan Commercial |
$19,580.00
|
| Rate for Payer: Cigna of CA HMO |
$15,664.00
|
| Rate for Payer: Cigna of CA PPO |
$18,111.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,803.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,803.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,803.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,790.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,790.00
|
| Rate for Payer: Galaxy Health WC |
$20,803.75
|
| Rate for Payer: Global Benefits Group Commercial |
$14,685.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,027.50
|
| Rate for Payer: InnovAge PACE Commercial |
$12,237.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,324.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,150.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,895.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,132.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,132.50
|
| Rate for Payer: Multiplan Commercial |
$18,356.25
|
| Rate for Payer: Networks By Design Commercial |
$15,908.75
|
| Rate for Payer: Prime Health Services Commercial |
$20,803.75
|
| Rate for Payer: Riverside University Health System MISP |
$9,790.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,685.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,803.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,803.75
|
| Rate for Payer: Vantage Medical Group Senior |
$20,803.75
|
|
|
HC PTA INTRACRAN VASOSPASM
|
Facility
|
IP
|
$24,475.00
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
909081015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,895.00 |
| Max. Negotiated Rate |
$22,027.50 |
| Rate for Payer: Adventist Health Commercial |
$4,895.00
|
| Rate for Payer: Cash Price |
$11,013.75
|
| Rate for Payer: Central Health Plan Commercial |
$19,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,790.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,790.00
|
| Rate for Payer: Galaxy Health WC |
$20,803.75
|
| Rate for Payer: Global Benefits Group Commercial |
$14,685.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,027.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,324.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,324.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,150.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,895.00
|
| Rate for Payer: Multiplan Commercial |
$18,356.25
|
| Rate for Payer: Networks By Design Commercial |
$15,908.75
|
| Rate for Payer: Prime Health Services Commercial |
$20,803.75
|
|
|
HC PT APPLICATION HOT/COLD PACKS
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 97010
|
| Hospital Charge Code |
905103104
|
|
Hospital Revenue Code
|
420
|
| 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 PT APPLICATION HOT/COLD PACKS
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 97010
|
| Hospital Charge Code |
905103104
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$56.17
|
| 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 |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| 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 |
$16.92
|
| 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 |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.17
|
| 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 |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
OP
|
$11,602.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$817.74 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,320.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$5,220.90
|
| Rate for Payer: Cash Price |
$5,220.90
|
| Rate for Payer: Cash Price |
$5,220.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,281.60
|
| Rate for Payer: Cigna of CA HMO |
$7,425.28
|
| Rate for Payer: Cigna of CA PPO |
$8,585.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$9,861.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,961.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,441.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$817.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,738.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$903.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,320.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$8,701.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$7,541.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$9,861.70
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,961.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
IP
|
$11,602.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.40 |
| Max. Negotiated Rate |
$10,441.80 |
| Rate for Payer: Adventist Health Commercial |
$2,320.40
|
| Rate for Payer: Cash Price |
$5,220.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,281.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,640.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,640.80
|
| Rate for Payer: Galaxy Health WC |
$9,861.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,961.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,441.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,738.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,420.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,181.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,320.40
|
| Rate for Payer: Multiplan Commercial |
$8,701.50
|
| Rate for Payer: Networks By Design Commercial |
$7,541.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,861.70
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
OP
|
$13,650.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
906820152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$817.74 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,730.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$6,142.50
|
| Rate for Payer: Cash Price |
$6,142.50
|
| Rate for Payer: Cash Price |
$6,142.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,920.00
|
| Rate for Payer: Cigna of CA HMO |
$8,736.00
|
| Rate for Payer: Cigna of CA PPO |
$10,101.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$11,602.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,190.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,285.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$817.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,104.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$903.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$10,237.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$8,872.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$11,602.50
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,190.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
IP
|
$13,650.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
906820152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,730.00 |
| Max. Negotiated Rate |
$12,285.00 |
| Rate for Payer: Adventist Health Commercial |
$2,730.00
|
| Rate for Payer: Cash Price |
$6,142.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,920.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,460.00
|
| Rate for Payer: Galaxy Health WC |
$11,602.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,190.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,285.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,104.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,200.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,449.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$10,237.50
|
| Rate for Payer: Networks By Design Commercial |
$8,872.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,602.50
|
|
