|
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 |
$241.66
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$263.61
|
| 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 Foundation Hospitals Commercial/Self Funded |
$239.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.19
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$263.61
|
| 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 Foundation Hospitals Commercial/Self Funded |
$239.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.19
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$159.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$144.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.02
|
| 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: 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 |
$145.76
|
| Rate for Payer: Cash Price |
$102.22
|
| Rate for Payer: Cigna of CA HMO |
$145.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$159.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$144.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.02
|
| 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
|
|
|
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: 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: 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 |
$2,601.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$256.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$233.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$216.53
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$256.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$233.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$216.53
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$321.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$291.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.81
|
| 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 |
$2,601.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$321.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$291.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.81
|
| 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
|
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 |
$2,601.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$337.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.38
|
| 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 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: Cash Price |
$216.90
|
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$337.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.38
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| 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 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 |
$2,601.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| 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 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: Galaxy Health WC |
$311.95
|
| 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 |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| 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 |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$256.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$305.91
|
| 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 |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$256.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$233.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$216.53
|
| 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 30 MIN W PT
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
900100700
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$525.93 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$525.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.31
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna of CA HMO |
$145.92
|
| Rate for Payer: Cigna of CA PPO |
$168.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
HC PSYCHOTHERAPY 30 MIN W PT
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
900100700
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Senior |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
|
|
HC PSYCHOTHERAPY 45 MIN W PT
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
900100701
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$764.74 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$764.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.86
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$112.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
HC PSYCHOTHERAPY 45 MIN W PT
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
900100701
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
900100702
|
|
Hospital Revenue Code
|
914
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$321.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$291.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.81
|
| 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 PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
900100702
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$1,047.07 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,047.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.54
|
| 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 |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$164.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$291.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$305.91
|
| 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: TriValley Medical Group Commercial/Senior |
$275.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
900100702
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$321.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$291.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.81
|
| 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 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: Prime Health Services WC |
$321.96
|
| 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 |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| 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 |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$291.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$305.91
|
| 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: 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 |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
HC PTA FEM/POP
|
Facility
|
IP
|
$15,757.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
909020065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,151.40 |
| Max. Negotiated Rate |
$13,393.45 |
| Rate for Payer: Adventist Health Commercial |
$3,151.40
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,029.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,302.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,302.80
|
| Rate for Payer: Galaxy Health WC |
$13,393.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,005.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,296.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.68
|
| Rate for Payer: Multiplan Commercial |
$12,605.60
|
| Rate for Payer: Networks By Design Commercial |
$10,242.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,393.45
|
|
|
HC PTA FEM/POP
|
Facility
|
OP
|
$15,757.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
909020065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,151.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,151.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,666.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,817.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Cigna of CA HMO |
$10,084.48
|
| Rate for Payer: Cigna of CA PPO |
$11,660.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,393.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,393.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,029.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,302.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,302.80
|
| Rate for Payer: Galaxy Health WC |
$13,393.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,005.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,719.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,296.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,029.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,029.90
|
| Rate for Payer: Multiplan Commercial |
$12,605.60
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$10,242.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,393.45
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,454.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,878.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,393.45
|
| Rate for Payer: Vantage Medical Group Senior |
$13,393.45
|
|
|
HC PTA ILIAC
|
Facility
|
OP
|
$15,757.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,151.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,151.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,666.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,817.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Cigna of CA HMO |
$10,084.48
|
| Rate for Payer: Cigna of CA PPO |
$11,660.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,393.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,393.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,029.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,302.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,302.80
|
| Rate for Payer: Galaxy Health WC |
$13,393.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,005.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,719.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,296.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,029.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,029.90
|
| Rate for Payer: Multiplan Commercial |
$12,605.60
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$10,242.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,393.45
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,454.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,878.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,393.45
|
| Rate for Payer: Vantage Medical Group Senior |
$13,393.45
|
|
