|
HC PRT FT MOLD SKT ANKL HI TOE FL
|
Facility
|
IP
|
$2,983.00
|
|
|
Service Code
|
CPT L5010
|
| Hospital Charge Code |
905355010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$596.60 |
| Max. Negotiated Rate |
$2,684.70 |
| Rate for Payer: Blue Shield of California EPN |
$1,592.92
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,386.40
|
| Rate for Payer: Cigna of CA HMO |
$2,088.10
|
| Rate for Payer: Cigna of CA PPO |
$2,088.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,193.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,193.20
|
| Rate for Payer: Galaxy Health WC |
$2,535.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,789.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,684.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,989.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,136.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.60
|
| Rate for Payer: Multiplan Commercial |
$2,237.25
|
| Rate for Payer: Networks By Design Commercial |
$1,491.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,535.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,126.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,100.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,076.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$984.39
|
|
|
HC PRT FT MOLD SKT ANKL HI TOE FL
|
Facility
|
OP
|
$2,983.00
|
|
|
Service Code
|
CPT L5010
|
| Hospital Charge Code |
905355010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,044.05 |
| Max. Negotiated Rate |
$2,684.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,535.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,640.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,640.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,444.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,762.36
|
| Rate for Payer: Blue Distinction Transplant |
$1,789.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,237.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,622.75
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,386.40
|
| Rate for Payer: Cigna of CA HMO |
$2,088.10
|
| Rate for Payer: Cigna of CA PPO |
$2,088.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,535.55
|
| Rate for Payer: Dignity Health Media |
$2,535.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,535.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,193.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,193.20
|
| Rate for Payer: Galaxy Health WC |
$2,535.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,789.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,684.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,237.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,044.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,989.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,061.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,223.03
|
| Rate for Payer: Multiplan Commercial |
$2,237.25
|
| Rate for Payer: Networks By Design Commercial |
$1,491.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,535.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,193.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,789.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,789.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,491.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,491.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,491.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,491.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,535.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,535.55
|
|
|
HC PRT FT MOLD SKT TIB TUBERCLE
|
Facility
|
IP
|
$4,241.00
|
|
|
Service Code
|
CPT L5020
|
| Hospital Charge Code |
905355020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$848.20 |
| Max. Negotiated Rate |
$3,816.90 |
| Rate for Payer: Blue Shield of California EPN |
$2,264.69
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,392.80
|
| Rate for Payer: Cigna of CA HMO |
$2,968.70
|
| Rate for Payer: Cigna of CA PPO |
$2,968.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,696.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,696.40
|
| Rate for Payer: Galaxy Health WC |
$3,604.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,544.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,816.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,828.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,615.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$848.20
|
| Rate for Payer: Multiplan Commercial |
$3,180.75
|
| Rate for Payer: Networks By Design Commercial |
$2,120.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,604.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,601.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1,564.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,530.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,399.53
|
|
|
HC PRT FT MOLD SKT TIB TUBERCLE
|
Facility
|
OP
|
$4,241.00
|
|
|
Service Code
|
CPT L5020
|
| Hospital Charge Code |
905355020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,484.35 |
| Max. Negotiated Rate |
$3,816.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,604.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,332.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,053.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,505.58
|
| Rate for Payer: Blue Distinction Transplant |
$2,544.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,180.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,307.10
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Cash Price |
$1,908.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,392.80
|
| Rate for Payer: Cigna of CA HMO |
$2,968.70
|
| Rate for Payer: Cigna of CA PPO |
$2,968.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,604.85
|
| Rate for Payer: Dignity Health Media |
$3,604.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,604.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,696.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,696.40
|
| Rate for Payer: Galaxy Health WC |
$3,604.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,544.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,816.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,180.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,484.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,828.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,349.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,738.81
|
| Rate for Payer: Multiplan Commercial |
$3,180.75
|
| Rate for Payer: Networks By Design Commercial |
$2,120.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,604.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,696.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,544.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,544.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,120.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,120.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,120.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,120.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,604.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,604.85
|
|
|
HC PSEUDOANEURYSM INJECT TRT
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$255.40 |
| Max. Negotiated Rate |
$1,149.30 |
| Rate for Payer: Cash Price |
$574.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,021.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.80
|
| Rate for Payer: Galaxy Health WC |
$1,085.45
|
| Rate for Payer: Global Benefits Group Commercial |
$766.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,149.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$851.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$486.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.40
|
| Rate for Payer: Multiplan Commercial |
$957.75
|
| Rate for Payer: Networks By Design Commercial |
$830.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,085.45
|
|
|
HC PSEUDOANEURYSM INJECT TRT
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$255.40 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$766.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$574.65
|
| Rate for Payer: Cash Price |
$574.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,021.60
|
| Rate for Payer: Cigna of CA PPO |
$944.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$1,085.45
|
| Rate for Payer: Global Benefits Group Commercial |
$766.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,149.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$957.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$851.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$957.75
|
| Rate for Payer: Networks By Design Commercial |
$830.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,085.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$766.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC PSTNR, NEONATAL Z-FLO 10X7
|
Facility
|
IP
|
$104.96
|
|
| Hospital Charge Code |
901605904
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$94.46 |
| Rate for Payer: Cash Price |
$47.23
|
| Rate for Payer: Central Health Plan Commercial |
$83.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.98
|
| Rate for Payer: Galaxy Health WC |
$89.22
|
| Rate for Payer: Global Benefits Group Commercial |
$62.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.99
|
| Rate for Payer: Multiplan Commercial |
$78.72
|
| Rate for Payer: Networks By Design Commercial |
$68.22
|
| Rate for Payer: Prime Health Services Commercial |
$89.22
|
|
|
HC PSTNR, NEONATAL Z-FLO 10X7
|
Facility
|
OP
|
$104.96
|
|
| Hospital Charge Code |
901605904
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$94.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.01
|
| Rate for Payer: Blue Distinction Transplant |
$62.98
|
| Rate for Payer: Blue Shield of California Commercial |
$66.02
|
| Rate for Payer: Blue Shield of California EPN |
$51.33
|
| Rate for Payer: Cash Price |
$47.23
|
| Rate for Payer: Central Health Plan Commercial |
$83.97
|
| Rate for Payer: Cigna of CA HMO |
$67.17
|
| Rate for Payer: Cigna of CA PPO |
$77.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.22
|
| Rate for Payer: Dignity Health Media |
$89.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.98
|
| Rate for Payer: Galaxy Health WC |
$89.22
|
| Rate for Payer: Global Benefits Group Commercial |
$62.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.99
|
| Rate for Payer: Multiplan Commercial |
$78.72
|
| Rate for Payer: Networks By Design Commercial |
$68.22
|
| Rate for Payer: Prime Health Services Commercial |
$89.22
|
| Rate for Payer: Riverside University Health System MISP |
$41.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.48
|
| Rate for Payer: United Healthcare All Other HMO |
$52.48
|
| Rate for Payer: United Healthcare HMO Rider |
$52.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.22
|
| Rate for Payer: Vantage Medical Group Senior |
$89.22
|
|
|
HC PSTNR, NEONATAL Z-FLO 16X24
|
Facility
|
IP
|
$571.53
|
|
| Hospital Charge Code |
901605556
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$114.31 |
| Max. Negotiated Rate |
$514.38 |
| Rate for Payer: Cash Price |
$257.19
|
| Rate for Payer: Central Health Plan Commercial |
$457.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.61
|
| Rate for Payer: Galaxy Health WC |
$485.80
|
| Rate for Payer: Global Benefits Group Commercial |
$342.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$514.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$381.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.31
|
| Rate for Payer: Multiplan Commercial |
$428.65
|
| Rate for Payer: Networks By Design Commercial |
$371.49
|
| Rate for Payer: Prime Health Services Commercial |
$485.80
|
|
|
HC PSTNR, NEONATAL Z-FLO 16X24
|
Facility
|
OP
|
$571.53
|
|
| Hospital Charge Code |
901605556
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$114.31 |
| Max. Negotiated Rate |
$514.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$347.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$314.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$314.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$276.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.66
|
| Rate for Payer: Blue Distinction Transplant |
$342.92
|
| Rate for Payer: Blue Shield of California Commercial |
$359.49
|
| Rate for Payer: Blue Shield of California EPN |
$279.48
|
| Rate for Payer: Cash Price |
$257.19
|
| Rate for Payer: Central Health Plan Commercial |
$457.22
|
| Rate for Payer: Cigna of CA HMO |
$365.78
|
| Rate for Payer: Cigna of CA PPO |
$422.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.80
|
| Rate for Payer: Dignity Health Media |
$485.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$228.61
|
| Rate for Payer: Galaxy Health WC |
$485.80
|
| Rate for Payer: Global Benefits Group Commercial |
$342.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$514.38
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$428.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$381.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.31
|
| Rate for Payer: Multiplan Commercial |
$428.65
|
| Rate for Payer: Networks By Design Commercial |
$371.49
|
| Rate for Payer: Prime Health Services Commercial |
$485.80
|
| Rate for Payer: Riverside University Health System MISP |
$228.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$285.76
|
| Rate for Payer: United Healthcare All Other HMO |
$285.76
|
| Rate for Payer: United Healthcare HMO Rider |
$285.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$485.80
|
| Rate for Payer: Vantage Medical Group Senior |
$485.80
|
|
|
HC PSTNR, ZFLO NEO 12X20 PICK1300
|
Facility
|
IP
|
$497.87
|
|
| Hospital Charge Code |
901605552
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.57 |
| Max. Negotiated Rate |
$448.08 |
| Rate for Payer: Cash Price |
$224.04
|
| Rate for Payer: Central Health Plan Commercial |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: Galaxy Health WC |
$423.19
|
| Rate for Payer: Global Benefits Group Commercial |
$298.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$448.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.57
|
| Rate for Payer: Multiplan Commercial |
$373.40
|
| Rate for Payer: Networks By Design Commercial |
$323.62
|
| Rate for Payer: Prime Health Services Commercial |
$423.19
|
|
|
HC PSTNR, ZFLO NEO 12X20 PICK1300
|
Facility
|
OP
|
$497.87
|
|
| Hospital Charge Code |
901605552
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.57 |
| Max. Negotiated Rate |
$448.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$302.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$423.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$241.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.14
|
| Rate for Payer: Blue Distinction Transplant |
$298.72
|
| Rate for Payer: Blue Shield of California Commercial |
$313.16
|
| Rate for Payer: Blue Shield of California EPN |
$243.46
|
| Rate for Payer: Cash Price |
$224.04
|
| Rate for Payer: Central Health Plan Commercial |
$398.30
|
| Rate for Payer: Cigna of CA HMO |
$318.64
|
| Rate for Payer: Cigna of CA PPO |
$368.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$423.19
|
| Rate for Payer: Dignity Health Media |
$423.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$423.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.15
|
| Rate for Payer: Galaxy Health WC |
$423.19
|
| Rate for Payer: Global Benefits Group Commercial |
$298.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$448.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$373.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$174.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.57
|
| Rate for Payer: Multiplan Commercial |
$373.40
|
| Rate for Payer: Networks By Design Commercial |
$323.62
|
| Rate for Payer: Prime Health Services Commercial |
$423.19
|
| Rate for Payer: Riverside University Health System MISP |
$199.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$298.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$298.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.94
|
| Rate for Payer: United Healthcare All Other HMO |
$248.94
|
| Rate for Payer: United Healthcare HMO Rider |
$248.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$423.19
|
| Rate for Payer: Vantage Medical Group Senior |
$423.19
|
|
|
HC PSTNR ZFLO NEO CVR STRAPS 20"
|
Facility
|
OP
|
$128.59
|
|
| Hospital Charge Code |
901698808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.72 |
| Max. Negotiated Rate |
$115.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.97
|
| Rate for Payer: Blue Distinction Transplant |
$77.15
|
| Rate for Payer: Blue Shield of California Commercial |
$80.88
|
| Rate for Payer: Blue Shield of California EPN |
$62.88
|
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Central Health Plan Commercial |
$102.87
|
| Rate for Payer: Cigna of CA HMO |
$82.30
|
| Rate for Payer: Cigna of CA PPO |
$95.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.30
|
| Rate for Payer: Dignity Health Media |
$109.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.44
|
| Rate for Payer: Galaxy Health WC |
$109.30
|
| Rate for Payer: Global Benefits Group Commercial |
$77.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$96.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.72
|
| Rate for Payer: Multiplan Commercial |
$96.44
|
| Rate for Payer: Networks By Design Commercial |
$83.58
|
| Rate for Payer: Prime Health Services Commercial |
$109.30
|
| Rate for Payer: Riverside University Health System MISP |
$51.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.30
|
| Rate for Payer: United Healthcare All Other HMO |
$64.30
|
| Rate for Payer: United Healthcare HMO Rider |
$64.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.30
|
| Rate for Payer: Vantage Medical Group Senior |
$109.30
|
|
|
HC PSTNR ZFLO NEO CVR STRAPS 20"
|
Facility
|
IP
|
$128.59
|
|
| Hospital Charge Code |
901698808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.72 |
| Max. Negotiated Rate |
$115.73 |
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Central Health Plan Commercial |
$102.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.44
|
| Rate for Payer: Galaxy Health WC |
$109.30
|
| Rate for Payer: Global Benefits Group Commercial |
$77.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.72
|
| Rate for Payer: Multiplan Commercial |
$96.44
|
| Rate for Payer: Networks By Design Commercial |
$83.58
|
| Rate for Payer: Prime Health Services Commercial |
$109.30
|
|
|
HC PSTNR ZFLO NEO LG W/CVR 12X20"
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698806
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC PSTNR ZFLO NEO LG W/CVR 12X20"
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698806
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC PSTNR ZFLO NEO MED W/CVR 9X15"
|
Facility
|
IP
|
$184.73
|
|
| Hospital Charge Code |
901698807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.95 |
| Max. Negotiated Rate |
$166.26 |
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Central Health Plan Commercial |
$147.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.89
|
| Rate for Payer: Galaxy Health WC |
$157.02
|
| Rate for Payer: Global Benefits Group Commercial |
$110.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.95
|
| Rate for Payer: Multiplan Commercial |
$138.55
|
| Rate for Payer: Networks By Design Commercial |
$120.07
|
| Rate for Payer: Prime Health Services Commercial |
$157.02
|
|
|
HC PSTNR ZFLO NEO MED W/CVR 9X15"
|
Facility
|
OP
|
$184.73
|
|
| Hospital Charge Code |
901698807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.95 |
| Max. Negotiated Rate |
$166.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.14
|
| Rate for Payer: Blue Distinction Transplant |
$110.84
|
| Rate for Payer: Blue Shield of California Commercial |
$116.20
|
| Rate for Payer: Blue Shield of California EPN |
$90.33
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Central Health Plan Commercial |
$147.78
|
| Rate for Payer: Cigna of CA HMO |
$118.23
|
| Rate for Payer: Cigna of CA PPO |
$136.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.02
|
| Rate for Payer: Dignity Health Media |
$157.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.89
|
| Rate for Payer: Galaxy Health WC |
$157.02
|
| Rate for Payer: Global Benefits Group Commercial |
$110.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$138.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.95
|
| Rate for Payer: Multiplan Commercial |
$138.55
|
| Rate for Payer: Networks By Design Commercial |
$120.07
|
| Rate for Payer: Prime Health Services Commercial |
$157.02
|
| Rate for Payer: Riverside University Health System MISP |
$73.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.36
|
| Rate for Payer: United Healthcare All Other HMO |
$92.36
|
| Rate for Payer: United Healthcare HMO Rider |
$92.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.02
|
| Rate for Payer: Vantage Medical Group Senior |
$157.02
|
|
|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
|
|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
|
|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$521.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$521.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$194.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.91
|
| Rate for Payer: Blue Distinction Transplant |
$240.60
|
| Rate for Payer: Blue Shield of California Commercial |
$252.23
|
| Rate for Payer: Blue Shield of California EPN |
$196.09
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$256.64
|
| Rate for Payer: Cigna of CA PPO |
$296.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Media |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$300.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$140.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Riverside University Health System MISP |
$160.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$200.50
|
| Rate for Payer: United Healthcare All Other HMO |
$200.50
|
| Rate for Payer: United Healthcare HMO Rider |
$200.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$521.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$521.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$194.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.91
|
| Rate for Payer: Blue Distinction Transplant |
$240.60
|
| Rate for Payer: Blue Shield of California Commercial |
$252.23
|
| Rate for Payer: Blue Shield of California EPN |
$196.09
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$256.64
|
| Rate for Payer: Cigna of CA PPO |
$296.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Media |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$300.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$140.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Riverside University Health System MISP |
$160.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$200.50
|
| Rate for Payer: United Healthcare All Other HMO |
$200.50
|
| Rate for Payer: United Healthcare HMO Rider |
$200.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC PSYCH 45 MIN W PT W EVAL
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
900100704
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$736.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$736.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$425.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$275.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$242.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$295.99
|
| Rate for Payer: Blue Distinction Transplant |
$300.60
|
| Rate for Payer: Blue Shield of California Commercial |
$315.13
|
| Rate for Payer: Blue Shield of California EPN |
$244.99
|
| Rate for Payer: Cash Price |
$225.45
|
| Rate for Payer: Cash Price |
$225.45
|
| Rate for Payer: Central Health Plan Commercial |
$400.80
|
| Rate for Payer: Cigna of CA HMO |
$320.64
|
| Rate for Payer: Cigna of CA PPO |
$370.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$425.85
|
| Rate for Payer: Dignity Health Media |
$425.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$200.40
|
| Rate for Payer: Galaxy Health WC |
$425.85
|
| Rate for Payer: Global Benefits Group Commercial |
$300.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$375.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$175.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.20
|
| Rate for Payer: Multiplan Commercial |
$375.75
|
| Rate for Payer: Networks By Design Commercial |
$325.65
|
| Rate for Payer: Prime Health Services Commercial |
$425.85
|
| Rate for Payer: Riverside University Health System MISP |
$200.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$300.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$250.50
|
| Rate for Payer: United Healthcare All Other HMO |
$250.50
|
| Rate for Payer: United Healthcare HMO Rider |
$250.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.85
|
| Rate for Payer: Vantage Medical Group Senior |
$425.85
|
|
|
HC PSYCH 45 MIN W PT W EVAL
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
900100704
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$450.90 |
| Rate for Payer: Cash Price |
$225.45
|
| Rate for Payer: Central Health Plan Commercial |
$400.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.40
|
| Rate for Payer: Galaxy Health WC |
$425.85
|
| Rate for Payer: Global Benefits Group Commercial |
$300.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.20
|
| Rate for Payer: Multiplan Commercial |
$375.75
|
| Rate for Payer: Networks By Design Commercial |
$325.65
|
| Rate for Payer: Prime Health Services Commercial |
$425.85
|
|
|
HC PSYCH 60 MIN W PT W EVAL
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
900100705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$846.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$846.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$447.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$289.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$289.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$254.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.76
|
| Rate for Payer: Blue Distinction Transplant |
$315.60
|
| Rate for Payer: Blue Shield of California Commercial |
$330.85
|
| Rate for Payer: Blue Shield of California EPN |
$257.21
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$336.64
|
| Rate for Payer: Cigna of CA PPO |
$389.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$447.10
|
| Rate for Payer: Dignity Health Media |
$447.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$447.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$394.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$184.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Riverside University Health System MISP |
$210.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.00
|
| Rate for Payer: United Healthcare All Other HMO |
$263.00
|
| Rate for Payer: United Healthcare HMO Rider |
$263.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$447.10
|
| Rate for Payer: Vantage Medical Group Senior |
$447.10
|
|
