|
HC PSEUDOANEURYSM INJECT TRT
|
Facility
|
OP
|
$1,248.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$249.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$798.72
|
| Rate for Payer: Cigna of CA PPO |
$923.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$1,060.80
|
| Rate for Payer: Global Benefits Group Commercial |
$748.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$262.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$832.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$998.40
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$811.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,060.80
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC PSEUDOANEURYSM INJECT TRT
|
Facility
|
IP
|
$1,248.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$1,060.80 |
| Rate for Payer: Adventist Health Commercial |
$249.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.20
|
| Rate for Payer: EPIC Health Plan Senior |
$499.20
|
| Rate for Payer: Galaxy Health WC |
$1,060.80
|
| Rate for Payer: Global Benefits Group Commercial |
$748.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$832.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$475.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$772.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.52
|
| Rate for Payer: Multiplan Commercial |
$998.40
|
| Rate for Payer: Networks By Design Commercial |
$811.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,060.80
|
|
|
HC PSTNR, NEONATAL Z-FLO 10X7
|
Facility
|
OP
|
$135.89
|
|
| Hospital Charge Code |
901605904
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$115.51 |
| Rate for Payer: Adventist Health Commercial |
$27.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$115.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.45
|
| Rate for Payer: Cash Price |
$61.15
|
| Rate for Payer: Cigna of CA HMO |
$86.97
|
| Rate for Payer: Cigna of CA PPO |
$100.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$115.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$115.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$115.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.36
|
| Rate for Payer: EPIC Health Plan Senior |
$54.36
|
| Rate for Payer: Galaxy Health WC |
$115.51
|
| Rate for Payer: Global Benefits Group Commercial |
$81.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.12
|
| Rate for Payer: Multiplan Commercial |
$108.71
|
| Rate for Payer: Networks By Design Commercial |
$88.33
|
| Rate for Payer: Prime Health Services Commercial |
$115.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.94
|
| Rate for Payer: United Healthcare All Other HMO |
$67.94
|
| Rate for Payer: United Healthcare HMO Rider |
$67.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$115.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.51
|
| Rate for Payer: Vantage Medical Group Senior |
$115.51
|
|
|
HC PSTNR, NEONATAL Z-FLO 10X7
|
Facility
|
IP
|
$135.89
|
|
| Hospital Charge Code |
901605904
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$115.51 |
| Rate for Payer: Adventist Health Commercial |
$27.18
|
| Rate for Payer: Cash Price |
$61.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.36
|
| Rate for Payer: EPIC Health Plan Senior |
$54.36
|
| Rate for Payer: Galaxy Health WC |
$115.51
|
| Rate for Payer: Global Benefits Group Commercial |
$81.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.61
|
| Rate for Payer: Multiplan Commercial |
$108.71
|
| Rate for Payer: Networks By Design Commercial |
$88.33
|
| Rate for Payer: Prime Health Services Commercial |
$115.51
|
|
|
HC PSTNR, NEONATAL Z-FLO 16X24
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901605556
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC PSTNR, NEONATAL Z-FLO 16X24
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901605556
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
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 |
$423.19 |
| Rate for Payer: Adventist Health Commercial |
$99.57
|
| Rate for Payer: Cash Price |
$224.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$199.15
|
| Rate for Payer: Galaxy Health WC |
$423.19
|
| Rate for Payer: Global Benefits Group Commercial |
$298.72
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$308.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.49
|
| Rate for Payer: Multiplan Commercial |
$398.30
|
| 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 |
$423.19 |
| Rate for Payer: Adventist Health Commercial |
$99.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$326.55
|
| 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 |
$373.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.74
|
| Rate for Payer: Cash Price |
$224.04
|
| 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 Medi-Cal |
$423.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$423.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$199.15
|
| Rate for Payer: Galaxy Health WC |
$423.19
|
| Rate for Payer: Global Benefits Group Commercial |
$298.72
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$308.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$348.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$348.51
|
| Rate for Payer: Multiplan Commercial |
$398.30
|
| Rate for Payer: Networks By Design Commercial |
$323.62
|
| Rate for Payer: Prime Health Services Commercial |
$423.19
|
| 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 Commercial/Exchange |
$423.19
|
| 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
|
$19.02
|
|
| Hospital Charge Code |
901698808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.68
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cigna of CA HMO |
$12.17
|
| Rate for Payer: Cigna of CA PPO |
$14.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.17
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.31
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Senior |
$16.17
|
|
|
HC PSTNR ZFLO NEO CVR STRAPS 20"
|
Facility
|
IP
|
$19.02
|
|
| Hospital Charge Code |
901698808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.17
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
|
|
HC PSTNR ZFLO NEO LG W/CVR 12X20"
|
Facility
|
OP
|
$376.59
|
|
| Hospital Charge Code |
901698806
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$320.10 |
| Rate for Payer: Adventist Health Commercial |
$75.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.26
|
| Rate for Payer: Cash Price |
$169.47
|
| Rate for Payer: Cigna of CA HMO |
$241.02
|
| Rate for Payer: Cigna of CA PPO |
$278.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.64
|
| Rate for Payer: EPIC Health Plan Senior |
$150.64
|
| Rate for Payer: Galaxy Health WC |
$320.10
|
| Rate for Payer: Global Benefits Group Commercial |
$225.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.61
|
| Rate for Payer: Multiplan Commercial |
$301.27
|
| Rate for Payer: Networks By Design Commercial |
$244.78
|
| Rate for Payer: Prime Health Services Commercial |
$320.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$225.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.29
|
| Rate for Payer: United Healthcare All Other HMO |
$188.29
|
| Rate for Payer: United Healthcare HMO Rider |
$188.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.10
|
| Rate for Payer: Vantage Medical Group Senior |
$320.10
|
|
|
HC PSTNR ZFLO NEO LG W/CVR 12X20"
|
Facility
|
IP
|
$376.59
|
|
| Hospital Charge Code |
901698806
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$320.10 |
| Rate for Payer: Adventist Health Commercial |
$75.32
|
| Rate for Payer: Cash Price |
$169.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.64
|
| Rate for Payer: EPIC Health Plan Senior |
$150.64
|
| Rate for Payer: Galaxy Health WC |
$320.10
|
| Rate for Payer: Global Benefits Group Commercial |
$225.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.38
|
| Rate for Payer: Multiplan Commercial |
$301.27
|
| Rate for Payer: Networks By Design Commercial |
$244.78
|
| Rate for Payer: Prime Health Services Commercial |
$320.10
|
|
|
HC PSTNR ZFLO NEO MED W/CVR 9X15"
|
Facility
|
IP
|
$227.15
|
|
| Hospital Charge Code |
901698807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$193.08 |
| Rate for Payer: Adventist Health Commercial |
$45.43
|
| Rate for Payer: Cash Price |
$102.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.86
|
| Rate for Payer: EPIC Health Plan Senior |
$90.86
|
| Rate for Payer: Galaxy Health WC |
$193.08
|
| Rate for Payer: Global Benefits Group Commercial |
$136.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.52
|
| Rate for Payer: Multiplan Commercial |
$181.72
|
| Rate for Payer: Networks By Design Commercial |
$147.65
|
| Rate for Payer: Prime Health Services Commercial |
$193.08
|
|
|
HC PSTNR ZFLO NEO MED W/CVR 9X15"
|
Facility
|
OP
|
$227.15
|
|
| Hospital Charge Code |
901698807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$193.08 |
| Rate for Payer: Cigna of CA PPO |
$168.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.86
|
| Rate for Payer: EPIC Health Plan Senior |
$90.86
|
| Rate for Payer: Galaxy Health WC |
$193.08
|
| Rate for Payer: Global Benefits Group Commercial |
$136.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$159.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$181.72
|
| Rate for Payer: Networks By Design Commercial |
$147.65
|
| Rate for Payer: Prime Health Services Commercial |
$193.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.58
|
| Rate for Payer: United Healthcare All Other HMO |
$113.58
|
| Rate for Payer: United Healthcare HMO Rider |
$113.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$193.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.08
|
| Rate for Payer: Vantage Medical Group Senior |
$193.08
|
| Rate for Payer: Adventist Health Commercial |
$45.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$170.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.49
|
| Rate for Payer: Cash Price |
$102.22
|
| Rate for Payer: Cigna of CA HMO |
$145.38
|
|
|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$275.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA HMO |
$234.88
|
| Rate for Payer: Cigna of CA PPO |
$271.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$256.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$256.90
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.50
|
| Rate for Payer: United Healthcare All Other HMO |
$183.50
|
| Rate for Payer: United Healthcare HMO Rider |
$183.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.95
|
| Rate for Payer: Vantage Medical Group Senior |
$311.95
|
|
|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
|
|
HC PSYCH 45 MIN W PT W EVAL
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
900100704
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: EPIC Health Plan Senior |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
|
|
HC PSYCH 45 MIN W PT W EVAL
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
900100704
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$344.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cigna of CA HMO |
$293.76
|
| Rate for Payer: Cigna of CA PPO |
$339.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$390.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$390.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: EPIC Health Plan Senior |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$321.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$321.30
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.50
|
| Rate for Payer: United Healthcare All Other HMO |
$229.50
|
| Rate for Payer: United Healthcare HMO Rider |
$229.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$390.15
|
| Rate for Payer: Vantage Medical Group Senior |
$390.15
|
|
|
HC PSYCH 60 MIN W PT W EVAL
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
900100705
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
|
|
HC PSYCH 60 MIN W PT W EVAL
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
900100705
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO |
$308.48
|
| Rate for Payer: Cigna of CA PPO |
$356.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$409.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.40
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.00
|
| Rate for Payer: United Healthcare All Other HMO |
$241.00
|
| Rate for Payer: United Healthcare HMO Rider |
$241.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.70
|
| Rate for Payer: Vantage Medical Group Senior |
$409.70
|
|
|
HC PSYCH CRISIS EA ADD 30 MIN
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
900100707
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.00
|
| Rate for Payer: United Healthcare All Other HMO |
$92.00
|
| Rate for Payer: United Healthcare HMO Rider |
$92.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PSYCH CRISIS EA ADD 30 MIN
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
900100707
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PSYCH CRISIS FIRST 60 MIN
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
900100706
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.22 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA HMO |
$234.88
|
| Rate for Payer: Cigna of CA PPO |
$271.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Senior |
$204.15
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$257.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.56
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Multiplan WC |
$325.28
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Prime Health Services WC |
$321.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.50
|
| Rate for Payer: United Healthcare All Other HMO |
$183.50
|
| Rate for Payer: United Healthcare HMO Rider |
$183.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$204.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Vantage Medical Group Senior |
$204.15
|
|
|
HC PSYCH CRISIS FIRST 60 MIN
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
900100706
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
|
|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
900100702
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cigna of CA HMO |
$293.76
|
| Rate for Payer: Cigna of CA PPO |
$339.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Senior |
$204.15
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$257.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.56
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Multiplan WC |
$325.28
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
| Rate for Payer: Prime Health Services WC |
$321.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.50
|
| Rate for Payer: United Healthcare All Other HMO |
$229.50
|
| Rate for Payer: United Healthcare HMO Rider |
$229.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$204.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Vantage Medical Group Senior |
$204.15
|
|
