|
HC SVC COPING SKILLS
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT G0177
|
| Hospital Charge Code |
907804014
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$178.75 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$195.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.75
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$243.75
|
|
|
HC SVC ED HEALTH EDUCATION
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804107
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$251.25 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$55.76
|
| Rate for Payer: Aetna of CA Government/Medicare |
$55.76
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Health Smart Auto/Commercial |
$201.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$201.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Mary Free Bed Workers' Compensation |
$41.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$251.25
|
|
|
HC SVC ED HEALTH EDUCATION
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT G0177
|
| Hospital Charge Code |
907804107
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$184.25 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$268.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$201.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$251.25
|
|
|
HC SVC ED HEALTH EDUCATION
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804107
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$725.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$55.76
|
| Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Shield of California Commercial |
$569.00
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$594.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$472.00
|
| Rate for Payer: Heritage Provider Network Senior |
$472.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage |
$463.00
|
| Rate for Payer: Intervalley Health Plan Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$522.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Magellan Commercial |
$637.00
|
| Rate for Payer: Managed Health Network (MHN) Commercial |
$682.00
|
| Rate for Payer: Managed Health Network (MHN) Medicare |
$111.37
|
| Rate for Payer: Mary Free Bed Workers' Compensation |
$41.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$251.25
|
| Rate for Payer: US Behavioral Health Commercial/Medicare |
$498.68
|
|
|
HC SVC ED HEALTH EDUCATION
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT G0177
|
| Hospital Charge Code |
907804107
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$184.25 |
| Max. Negotiated Rate |
$251.25 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$201.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$201.00
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Health Smart Auto/Commercial |
$201.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$201.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$251.25
|
|
|
HC SVC ED HEALTH EDUCATION
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804107
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$184.25 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$268.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$201.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$251.25
|
|
|
HC SVC ED HEALTH EDUCATION
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804107
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$184.25 |
| Max. Negotiated Rate |
$597.00 |
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$268.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$201.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Mary Free Bed Workers' Compensation |
$597.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$251.25
|
|
|
HC SVC ED MENTAL HEALTH EDUCATION
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804106
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$184.25 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$268.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$201.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$251.25
|
|
|
HC SVC ED MENTAL HEALTH EDUCATION
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804106
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$725.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$55.76
|
| Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Shield of California Commercial |
$569.00
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$594.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$472.00
|
| Rate for Payer: Heritage Provider Network Senior |
$472.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage |
$463.00
|
| Rate for Payer: Intervalley Health Plan Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$522.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Magellan Commercial |
$637.00
|
| Rate for Payer: Managed Health Network (MHN) Commercial |
$682.00
|
| Rate for Payer: Managed Health Network (MHN) Medicare |
$111.37
|
| Rate for Payer: Mary Free Bed Workers' Compensation |
$41.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$251.25
|
| Rate for Payer: US Behavioral Health Commercial/Medicare |
$498.68
|
|
|
HC SVC ED MENTAL HEALTH EDUCATION
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804106
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$184.25 |
| Max. Negotiated Rate |
$597.00 |
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$268.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$201.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Mary Free Bed Workers' Compensation |
$597.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$251.25
|
|
|
HC SVC ED MENTAL HEALTH EDUCATION
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804106
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$251.25 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$55.76
|
| Rate for Payer: Aetna of CA Government/Medicare |
$55.76
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Health Smart Auto/Commercial |
$201.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$201.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Mary Free Bed Workers' Compensation |
$41.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$251.25
|
|
|
HC SVC ED MENTAL HEALTH EDUCATION
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT G0177
|
| Hospital Charge Code |
907804106
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$184.25 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$268.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$201.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$251.25
|
|
|
HC SVC ED MENTAL HEALTH EDUCATION
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT G0177
|
| Hospital Charge Code |
907804106
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$184.25 |
| Max. Negotiated Rate |
$251.25 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$201.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$201.00
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Health Smart Auto/Commercial |
$201.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$201.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$251.25
|
|
|
HC SVC ED STRESS MANAGEMENT
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804108
|
|
Hospital Revenue Code
|
904
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$280.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$210.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$262.50
|
|
|
HC SVC ED STRESS MANAGEMENT
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT G0176
|
| Hospital Charge Code |
907804108
|
|
Hospital Revenue Code
|
904
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$210.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$210.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Health Smart Auto/Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$210.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$262.50
|
|
|
HC SVC ED STRESS MANAGEMENT
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT G0176
|
| Hospital Charge Code |
907804108
|
|
Hospital Revenue Code
|
904
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$280.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$210.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$262.50
|
|
|
HC SVC ED STRESS MANAGEMENT
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804108
|
|
Hospital Revenue Code
|
904
|
| Min. Negotiated Rate |
$149.60 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$149.60
|
| Rate for Payer: Aetna of CA Government/Medicare |
$149.60
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Health Smart Auto/Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$210.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$262.50
|
|
|
HC SVC ED STRESS MANAGEMENT
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804108
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$149.60 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$725.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$149.60
|
| Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Shield of California Commercial |
$569.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$594.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$472.00
|
| Rate for Payer: Heritage Provider Network Senior |
$472.00
|
| Rate for Payer: Intervalley Health Plan Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$522.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.50
|
| Rate for Payer: Magellan Commercial |
$637.00
|
| Rate for Payer: Managed Health Network (MHN) Commercial |
$682.00
|
| Rate for Payer: Managed Health Network (MHN) Medicare |
$199.21
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$262.50
|
| Rate for Payer: US Behavioral Health Commercial/Medicare |
$498.68
|
|
|
HC SVC ED STRESS MANAGEMENT
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804108
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$597.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$280.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$210.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.50
|
| Rate for Payer: Mary Free Bed Workers' Compensation |
$597.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$262.50
|
|
|
HC SVC HEALTH EDUCATION
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804013
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$725.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$55.76
|
| Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Shield of California Commercial |
$569.00
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$594.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$472.00
|
| Rate for Payer: Heritage Provider Network Senior |
$472.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage |
$463.00
|
| Rate for Payer: Intervalley Health Plan Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$522.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.75
|
| Rate for Payer: Magellan Commercial |
$637.00
|
| Rate for Payer: Managed Health Network (MHN) Commercial |
$682.00
|
| Rate for Payer: Managed Health Network (MHN) Medicare |
$111.37
|
| Rate for Payer: Mary Free Bed Workers' Compensation |
$41.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$243.75
|
| Rate for Payer: US Behavioral Health Commercial/Medicare |
$498.68
|
|
|
HC SVC HEALTH EDUCATION
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT G0177
|
| Hospital Charge Code |
907804013
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$178.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$195.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$195.00
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Health Smart Auto/Commercial |
$195.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$195.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.75
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$243.75
|
|
|
HC SVC HEALTH EDUCATION
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804013
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$178.75 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$195.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.75
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$243.75
|
|
|
HC SVC HEALTH EDUCATION
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804013
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$55.76
|
| Rate for Payer: Aetna of CA Government/Medicare |
$55.76
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Health Smart Auto/Commercial |
$195.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$195.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.75
|
| Rate for Payer: Mary Free Bed Workers' Compensation |
$41.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$243.75
|
|
|
HC SVC HEALTH EDUCATION
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT G0177
|
| Hospital Charge Code |
907804013
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$178.75 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Health Smart Auto/Commercial |
$195.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.00
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.75
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$243.75
|
|
|
HC SVC HEALTH EDUCATION
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804013
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$178.75 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$195.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.75
|
| Rate for Payer: Mary Free Bed Workers' Compensation |
$644.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$243.75
|
|
