|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
IP
|
$501.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
900100702
|
|
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: 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 PSYCHOTHERAPY 60 MIN W PT
|
Facility
OP
|
$501.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
900100702
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$896.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$199.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$896.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$199.21
|
| 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: BCBS Transplant 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: Caremore Medicare Advantage |
$199.21
|
| 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 |
$298.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$199.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.21
|
| 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 Transplant Other |
$375.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.70
|
| Rate for Payer: IEHP medi-cal |
$328.70
|
| Rate for Payer: IEHP Medicare Advantage |
$199.21
|
| Rate for Payer: Innovage PACE Commercial |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.94
|
| 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: Prime Health Services Medicare |
$211.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$300.60
|
| Rate for Payer: Riverside University Health MISP |
$219.13
|
| 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 Commercial/Exchange |
$298.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Vantage Medical Group Senior |
$199.21
|
|
|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
OP
|
$501.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
900100702
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$896.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$199.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$896.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$199.21
|
| 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: BCBS Transplant 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: Caremore Medicare Advantage |
$199.21
|
| 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 |
$298.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$199.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.21
|
| 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 Transplant Other |
$375.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.70
|
| Rate for Payer: IEHP medi-cal |
$328.70
|
| Rate for Payer: IEHP Medicare Advantage |
$199.21
|
| Rate for Payer: Innovage PACE Commercial |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.94
|
| 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: Prime Health Services Medicare |
$211.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$300.60
|
| Rate for Payer: Riverside University Health MISP |
$219.13
|
| 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 Commercial/Exchange |
$298.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Vantage Medical Group Senior |
$199.21
|
|
|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
IP
|
$501.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
900100702
|
|
Hospital Revenue Code
|
510
|
| 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: 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 TESTING
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 96100
|
| Hospital Charge Code |
907804040
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$92.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$130.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$84.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$74.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.39
|
| Rate for Payer: BCBS Transplant Transplant |
$91.80
|
| Rate for Payer: Blue Shield of California Commercial |
$96.24
|
| Rate for Payer: Blue Shield of California EPN |
$74.82
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Central Health Plan Commercial |
$122.40
|
| Rate for Payer: Cigna of CA HMO |
$97.92
|
| Rate for Payer: Cigna of CA PPO |
$113.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$114.75
|
| Rate for Payer: IEHP medi-cal |
$53.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$800.00
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$91.80
|
| Rate for Payer: Riverside University Health MISP |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Other HMO |
$76.50
|
| Rate for Payer: United Healthcare HMO Rider |
$76.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.05
|
| Rate for Payer: Vantage Medical Group Senior |
$130.05
|
|
|
HC PSYCH TESTING
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 96100
|
| Hospital Charge Code |
907804040
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Central Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
|
|
HC PTA FEM/POP
|
Facility
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
906820148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,224.00 |
| Max. Negotiated Rate |
$14,508.00 |
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
|
|
HC PTA FEM/POP
|
Facility
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
906820148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,224.00 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,141.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$7,141.35
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: Cigna of CA PPO |
$11,928.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,090.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,711.81
|
| Rate for Payer: IEHP medi-cal |
$11,783.23
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Innovage PACE Commercial |
$10,712.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,569.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
| Rate for Payer: Prime Health Services Medicare |
$7,569.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,672.00
|
| Rate for Payer: Riverside University Health MISP |
$7,855.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,672.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTA FEM/POP
|
Facility
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
909020065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,224.00 |
| Max. Negotiated Rate |
$14,508.00 |
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
|
|
HC PTA FEM/POP
|
Facility
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
909020065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,224.00 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,141.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$7,141.35
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: Cigna of CA PPO |
$11,928.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,090.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,711.81
|
| Rate for Payer: IEHP medi-cal |
$11,783.23
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Innovage PACE Commercial |
$10,712.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,569.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
| Rate for Payer: Prime Health Services Medicare |
$7,569.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,672.00
|
| Rate for Payer: Riverside University Health MISP |
$7,855.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,672.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTA ILIAC
|
Facility
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,224.00 |
| Max. Negotiated Rate |
$14,508.00 |
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
|
|
HC PTA ILIAC
|
Facility
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,224.00 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,141.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$7,141.35
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: Cigna of CA PPO |
$11,928.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,090.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,711.81
|
| Rate for Payer: IEHP medi-cal |
$11,783.23
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Innovage PACE Commercial |
$10,712.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,569.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
| Rate for Payer: Prime Health Services Medicare |
$7,569.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,672.00
|
| Rate for Payer: Riverside University Health MISP |
$7,855.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,672.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTA ILIAC
|
Facility
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
906820144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,224.00 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,141.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$7,141.35
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: Cigna of CA PPO |
$11,928.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,090.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,711.81
|
| Rate for Payer: IEHP medi-cal |
$11,783.23
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Innovage PACE Commercial |
$10,712.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,569.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
| Rate for Payer: Prime Health Services Medicare |
$7,569.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,672.00
|
| Rate for Payer: Riverside University Health MISP |
$7,855.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,672.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTA ILIAC
|
Facility
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
906820144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,224.00 |
| Max. Negotiated Rate |
$14,508.00 |
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,062.80 |
| Max. Negotiated Rate |
$13,782.60 |
| 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: 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: 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
|
$15,314.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,901.00 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,422.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| 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 PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$11,485.50
|
| Rate for Payer: IEHP medi-cal |
$5,359.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,188.40
|
| Rate for Payer: Riverside University Health MISP |
$6,125.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
906820146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,901.00 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,422.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| 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 PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$11,485.50
|
| Rate for Payer: IEHP medi-cal |
$5,359.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,188.40
|
| Rate for Payer: Riverside University Health MISP |
$6,125.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
906820146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,062.80 |
| Max. Negotiated Rate |
$13,782.60 |
| 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: 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: 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 INTRACRAN VASO EA ADD DIFF
|
Facility
OP
|
$8,267.00
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
909081017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,653.40 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,346.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,026.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,546.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,546.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,960.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$3,720.15
|
| Rate for Payer: Cash Price |
$3,720.15
|
| Rate for Payer: Cash Price |
$3,720.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,613.60
|
| Rate for Payer: Cigna of CA PPO |
$6,117.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,026.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,306.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,306.80
|
| Rate for Payer: Galaxy Health WC |
$7,026.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,960.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,440.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,200.25
|
| Rate for Payer: IEHP medi-cal |
$2,893.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,514.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,653.40
|
| Rate for Payer: Multiplan Commercial |
$6,200.25
|
| Rate for Payer: Networks By Design Commercial |
$5,373.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,026.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,960.20
|
| Rate for Payer: Riverside University Health MISP |
$3,306.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,960.20
|
| 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 Medi-Cal |
$7,026.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7,026.95
|
|
|
HC PTA INTRACRAN VASO EA ADD DIFF
|
Facility
IP
|
$8,267.00
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
909081017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,653.40 |
| Max. Negotiated Rate |
$7,440.30 |
| Rate for Payer: Cash Price |
$3,720.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,613.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,306.80
|
| Rate for Payer: Galaxy Health WC |
$7,026.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,960.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,440.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,514.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,653.40
|
| Rate for Payer: Multiplan Commercial |
$6,200.25
|
| Rate for Payer: Networks By Design Commercial |
$5,373.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,026.95
|
|
|
HC PTA INTRACRAN VASOPAMS EA ADDL
|
Facility
OP
|
$9,270.00
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
909081016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,174.68 |
| Max. Negotiated Rate |
$8,343.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,174.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,879.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,098.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,098.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,562.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$4,171.50
|
| Rate for Payer: Cash Price |
$4,171.50
|
| Rate for Payer: Cash Price |
$4,171.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,416.00
|
| Rate for Payer: Cigna of CA PPO |
$6,859.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,879.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,708.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,708.00
|
| Rate for Payer: Galaxy Health WC |
$7,879.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,562.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,343.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,952.50
|
| Rate for Payer: IEHP medi-cal |
$3,244.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,183.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,854.00
|
| Rate for Payer: Multiplan Commercial |
$6,952.50
|
| Rate for Payer: Networks By Design Commercial |
$6,025.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,879.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,562.00
|
| Rate for Payer: Riverside University Health MISP |
$3,708.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,562.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,879.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7,879.50
|
|
|
HC PTA INTRACRAN VASOPAMS EA ADDL
|
Facility
IP
|
$9,270.00
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
909081016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,854.00 |
| Max. Negotiated Rate |
$8,343.00 |
| Rate for Payer: Cash Price |
$4,171.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,416.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,708.00
|
| Rate for Payer: Galaxy Health WC |
$7,879.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,562.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,343.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,183.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,854.00
|
| Rate for Payer: Multiplan Commercial |
$6,952.50
|
| Rate for Payer: Networks By Design Commercial |
$6,025.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,879.50
|
|
|
HC PTA INTRACRAN VASOSPASM
|
Facility
IP
|
$18,507.00
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
909081015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,701.40 |
| Max. Negotiated Rate |
$16,656.30 |
| Rate for Payer: Cash Price |
$8,328.15
|
| Rate for Payer: Central Health Plan Commercial |
$14,805.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,402.80
|
| Rate for Payer: Galaxy Health WC |
$15,730.95
|
| Rate for Payer: Global Benefits Group Commercial |
$11,104.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,656.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,344.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,701.40
|
| Rate for Payer: Multiplan Commercial |
$13,880.25
|
| Rate for Payer: Networks By Design Commercial |
$12,029.55
|
| Rate for Payer: Prime Health Services Commercial |
$15,730.95
|
|
|
HC PTA INTRACRAN VASOSPASM
|
Facility
OP
|
$18,507.00
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
909081015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,257.00 |
| Max. Negotiated Rate |
$16,656.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,340.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15,730.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,178.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,178.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: BCBS Transplant Transplant |
$11,104.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$8,328.15
|
| Rate for Payer: Cash Price |
$8,328.15
|
| Rate for Payer: Cash Price |
$8,328.15
|
| Rate for Payer: Central Health Plan Commercial |
$14,805.60
|
| Rate for Payer: Cigna of CA PPO |
$13,695.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,730.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,402.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,402.80
|
| Rate for Payer: Galaxy Health WC |
$15,730.95
|
| Rate for Payer: Global Benefits Group Commercial |
$11,104.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,656.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13,880.25
|
| Rate for Payer: IEHP medi-cal |
$6,477.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,344.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,701.40
|
| Rate for Payer: Multiplan Commercial |
$13,880.25
|
| Rate for Payer: Networks By Design Commercial |
$12,029.55
|
| Rate for Payer: Prime Health Services Commercial |
$15,730.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11,104.20
|
| Rate for Payer: Riverside University Health MISP |
$7,402.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,104.20
|
| 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 Medi-Cal |
$15,730.95
|
| Rate for Payer: Vantage Medical Group Senior |
$15,730.95
|
|
|
HC PT APPLICATION HOT/COLD PACKS
|
Facility
OP
|
$169.00
|
|
|
Service Code
|
CPT 97010
|
| Hospital Charge Code |
905103104
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$143.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$92.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$92.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Central Health Plan Commercial |
$135.20
|
| Rate for Payer: Cigna of CA HMO |
$108.16
|
| Rate for Payer: Cigna of CA PPO |
$125.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.60
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$126.75
|
| Rate for Payer: IEHP medi-cal |
$59.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.29
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$101.40
|
| Rate for Payer: Riverside University Health MISP |
$67.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.65
|
| Rate for Payer: Vantage Medical Group Senior |
$143.65
|
|
