|
HC ED EXP INTRFC OUTSIDE LKNG HNG
|
Facility
|
OP
|
$8,341.00
|
|
|
Service Code
|
CPT L6205
|
| Hospital Charge Code |
905356205
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,731.68 |
| Max. Negotiated Rate |
$7,506.90 |
| Rate for Payer: Adventist Health Commercial |
$3,419.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,089.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,587.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,255.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,851.96
|
| Rate for Payer: Blue Shield of California Commercial |
$6,689.48
|
| Rate for Payer: Blue Shield of California EPN |
$4,203.86
|
| Rate for Payer: Cash Price |
$3,753.45
|
| Rate for Payer: Cash Price |
$3,753.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,672.80
|
| Rate for Payer: Cigna of CA HMO |
$5,838.70
|
| Rate for Payer: Cigna of CA PPO |
$5,838.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,089.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,089.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,089.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,838.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,336.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,336.40
|
| Rate for Payer: Galaxy Health WC |
$7,089.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,004.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,506.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,544.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,296.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,915.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,921.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,419.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,838.70
|
| Rate for Payer: Multiplan Commercial |
$6,255.75
|
| Rate for Payer: Networks By Design Commercial |
$4,170.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,089.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,336.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,004.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,004.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,130.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3,046.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,981.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,731.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,089.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,089.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,089.85
|
|
|
HC ED EXTERN POWER SWITCH CONTROL
|
Facility
|
OP
|
$18,797.00
|
|
|
Service Code
|
CPT L6940
|
| Hospital Charge Code |
905356940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,156.02 |
| Max. Negotiated Rate |
$16,917.30 |
| Rate for Payer: Adventist Health Commercial |
$7,706.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,977.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,338.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,097.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,934.21
|
| Rate for Payer: Blue Shield of California Commercial |
$15,075.19
|
| Rate for Payer: Blue Shield of California EPN |
$9,473.69
|
| Rate for Payer: Cash Price |
$8,458.65
|
| Rate for Payer: Cash Price |
$8,458.65
|
| Rate for Payer: Central Health Plan Commercial |
$15,037.60
|
| Rate for Payer: Cigna of CA HMO |
$13,157.90
|
| Rate for Payer: Cigna of CA PPO |
$13,157.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,977.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,977.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,977.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,157.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,518.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,518.80
|
| Rate for Payer: Galaxy Health WC |
$15,977.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,278.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,917.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,794.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,936.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,505.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,090.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,706.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,157.90
|
| Rate for Payer: Multiplan Commercial |
$14,097.75
|
| Rate for Payer: Networks By Design Commercial |
$9,398.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,977.45
|
| Rate for Payer: Riverside University Health System MISP |
$7,518.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,278.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,278.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,054.51
|
| Rate for Payer: United Healthcare All Other HMO |
$6,866.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6,718.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,156.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,977.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,977.45
|
| Rate for Payer: Vantage Medical Group Senior |
$15,977.45
|
|
|
HC ED EXTERN POWER SWITCH CONTROL
|
Facility
|
IP
|
$18,797.00
|
|
|
Service Code
|
CPT L6940
|
| Hospital Charge Code |
915356940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,759.40 |
| Max. Negotiated Rate |
$16,917.30 |
| Rate for Payer: Adventist Health Commercial |
$3,759.40
|
| Rate for Payer: Blue Shield of California Commercial |
$15,075.19
|
| Rate for Payer: Blue Shield of California EPN |
$9,473.69
|
| Rate for Payer: Cash Price |
$8,458.65
|
| Rate for Payer: Central Health Plan Commercial |
$15,037.60
|
| Rate for Payer: Cigna of CA HMO |
$13,157.90
|
| Rate for Payer: Cigna of CA PPO |
$13,157.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,157.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,518.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,518.80
|
| Rate for Payer: Galaxy Health WC |
$15,977.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,278.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,917.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,936.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,090.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,759.40
|
| Rate for Payer: Multiplan Commercial |
$14,097.75
|
| Rate for Payer: Networks By Design Commercial |
$12,218.05
|
| Rate for Payer: Prime Health Services Commercial |
$15,977.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,054.51
|
| Rate for Payer: United Healthcare All Other HMO |
$6,866.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6,718.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,156.02
|
|
|
HC ED EXTERN POWER SWITCH CONTROL
|
Facility
|
OP
|
$18,797.00
|
|
|
Service Code
|
CPT L6940
|
| Hospital Charge Code |
915356940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,156.02 |
| Max. Negotiated Rate |
$16,917.30 |
| Rate for Payer: Adventist Health Commercial |
$7,706.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,977.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,338.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,097.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,934.21
|
| Rate for Payer: Blue Shield of California Commercial |
$15,075.19
|
| Rate for Payer: Blue Shield of California EPN |
$9,473.69
|
| Rate for Payer: Cash Price |
$8,458.65
|
| Rate for Payer: Cash Price |
$8,458.65
|
| Rate for Payer: Central Health Plan Commercial |
$15,037.60
|
| Rate for Payer: Cigna of CA HMO |
$13,157.90
|
| Rate for Payer: Cigna of CA PPO |
$13,157.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,977.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,977.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,977.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,157.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,518.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,518.80
|
| Rate for Payer: Galaxy Health WC |
$15,977.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,278.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,917.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,794.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,936.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,505.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,090.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,706.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,157.90
|
| Rate for Payer: Multiplan Commercial |
$14,097.75
|
| Rate for Payer: Networks By Design Commercial |
$9,398.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,977.45
|
| Rate for Payer: Riverside University Health System MISP |
$7,518.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,278.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,278.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,054.51
|
| Rate for Payer: United Healthcare All Other HMO |
$6,866.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6,718.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,156.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,977.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,977.45
|
| Rate for Payer: Vantage Medical Group Senior |
$15,977.45
|
|
|
HC ED EXTERN POWER SWITCH CONTROL
|
Facility
|
IP
|
$18,797.00
|
|
|
Service Code
|
CPT L6940
|
| Hospital Charge Code |
905356940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,759.40 |
| Max. Negotiated Rate |
$16,917.30 |
| Rate for Payer: Adventist Health Commercial |
$3,759.40
|
| Rate for Payer: Blue Shield of California Commercial |
$15,075.19
|
| Rate for Payer: Blue Shield of California EPN |
$9,473.69
|
| Rate for Payer: Cash Price |
$8,458.65
|
| Rate for Payer: Central Health Plan Commercial |
$15,037.60
|
| Rate for Payer: Cigna of CA HMO |
$13,157.90
|
| Rate for Payer: Cigna of CA PPO |
$13,157.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,157.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,518.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,518.80
|
| Rate for Payer: Galaxy Health WC |
$15,977.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,278.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,917.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,936.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,090.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,759.40
|
| Rate for Payer: Multiplan Commercial |
$14,097.75
|
| Rate for Payer: Networks By Design Commercial |
$12,218.05
|
| Rate for Payer: Prime Health Services Commercial |
$15,977.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,054.51
|
| Rate for Payer: United Healthcare All Other HMO |
$6,866.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6,718.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,156.02
|
|
|
HC ED EXTER POWER LOCK HINGE MYOE
|
Facility
|
IP
|
$23,343.00
|
|
|
Service Code
|
CPT L6945
|
| Hospital Charge Code |
915356945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,668.60 |
| Max. Negotiated Rate |
$21,008.70 |
| Rate for Payer: Adventist Health Commercial |
$4,668.60
|
| Rate for Payer: Blue Shield of California Commercial |
$18,721.09
|
| Rate for Payer: Blue Shield of California EPN |
$11,764.87
|
| Rate for Payer: Cash Price |
$10,504.35
|
| Rate for Payer: Central Health Plan Commercial |
$18,674.40
|
| Rate for Payer: Cigna of CA HMO |
$16,340.10
|
| Rate for Payer: Cigna of CA PPO |
$16,340.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,340.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,337.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,337.20
|
| Rate for Payer: Galaxy Health WC |
$19,841.55
|
| Rate for Payer: Global Benefits Group Commercial |
$14,005.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,008.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,822.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,772.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,668.60
|
| Rate for Payer: Multiplan Commercial |
$17,507.25
|
| Rate for Payer: Networks By Design Commercial |
$15,172.95
|
| Rate for Payer: Prime Health Services Commercial |
$19,841.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,760.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8,527.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8,342.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,644.83
|
|
|
HC ED EXTER POWER LOCK HINGE MYOE
|
Facility
|
OP
|
$23,343.00
|
|
|
Service Code
|
CPT L6945
|
| Hospital Charge Code |
915356945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,644.83 |
| Max. Negotiated Rate |
$21,008.70 |
| Rate for Payer: Adventist Health Commercial |
$9,570.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,841.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,838.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,507.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,578.62
|
| Rate for Payer: Blue Shield of California Commercial |
$18,721.09
|
| Rate for Payer: Blue Shield of California EPN |
$11,764.87
|
| Rate for Payer: Cash Price |
$10,504.35
|
| Rate for Payer: Cash Price |
$10,504.35
|
| Rate for Payer: Central Health Plan Commercial |
$18,674.40
|
| Rate for Payer: Cigna of CA HMO |
$16,340.10
|
| Rate for Payer: Cigna of CA PPO |
$16,340.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,841.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,841.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,841.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,340.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,337.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,337.20
|
| Rate for Payer: Galaxy Health WC |
$19,841.55
|
| Rate for Payer: Global Benefits Group Commercial |
$14,005.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,008.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,819.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,822.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,638.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,772.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,570.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,340.10
|
| Rate for Payer: Multiplan Commercial |
$17,507.25
|
| Rate for Payer: Networks By Design Commercial |
$11,671.50
|
| Rate for Payer: Prime Health Services Commercial |
$19,841.55
|
| Rate for Payer: Riverside University Health System MISP |
$9,337.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,005.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,005.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,760.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8,527.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8,342.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,644.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,841.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,841.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19,841.55
|
|
|
HC ED EXTER POWER LOCK HINGE MYOE
|
Facility
|
IP
|
$23,343.00
|
|
|
Service Code
|
CPT L6945
|
| Hospital Charge Code |
905356945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,668.60 |
| Max. Negotiated Rate |
$21,008.70 |
| Rate for Payer: Adventist Health Commercial |
$4,668.60
|
| Rate for Payer: Blue Shield of California Commercial |
$18,721.09
|
| Rate for Payer: Blue Shield of California EPN |
$11,764.87
|
| Rate for Payer: Cash Price |
$10,504.35
|
| Rate for Payer: Central Health Plan Commercial |
$18,674.40
|
| Rate for Payer: Cigna of CA HMO |
$16,340.10
|
| Rate for Payer: Cigna of CA PPO |
$16,340.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,340.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,337.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,337.20
|
| Rate for Payer: Galaxy Health WC |
$19,841.55
|
| Rate for Payer: Global Benefits Group Commercial |
$14,005.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,008.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,822.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,772.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,668.60
|
| Rate for Payer: Multiplan Commercial |
$17,507.25
|
| Rate for Payer: Networks By Design Commercial |
$15,172.95
|
| Rate for Payer: Prime Health Services Commercial |
$19,841.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,760.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8,527.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8,342.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,644.83
|
|
|
HC ED EXTER POWER LOCK HINGE MYOE
|
Facility
|
OP
|
$23,343.00
|
|
|
Service Code
|
CPT L6945
|
| Hospital Charge Code |
905356945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,644.83 |
| Max. Negotiated Rate |
$21,008.70 |
| Rate for Payer: Adventist Health Commercial |
$9,570.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,841.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,838.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,507.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,578.62
|
| Rate for Payer: Blue Shield of California Commercial |
$18,721.09
|
| Rate for Payer: Blue Shield of California EPN |
$11,764.87
|
| Rate for Payer: Cash Price |
$10,504.35
|
| Rate for Payer: Cash Price |
$10,504.35
|
| Rate for Payer: Central Health Plan Commercial |
$18,674.40
|
| Rate for Payer: Cigna of CA HMO |
$16,340.10
|
| Rate for Payer: Cigna of CA PPO |
$16,340.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,841.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,841.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,841.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,340.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,337.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,337.20
|
| Rate for Payer: Galaxy Health WC |
$19,841.55
|
| Rate for Payer: Global Benefits Group Commercial |
$14,005.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,008.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,819.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,822.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,638.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,772.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,570.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,340.10
|
| Rate for Payer: Multiplan Commercial |
$17,507.25
|
| Rate for Payer: Networks By Design Commercial |
$11,671.50
|
| Rate for Payer: Prime Health Services Commercial |
$19,841.55
|
| Rate for Payer: Riverside University Health System MISP |
$9,337.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,005.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,005.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,760.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8,527.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8,342.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,644.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,841.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,841.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19,841.55
|
|
|
HC ED FAMILY THERAPY WITH PATIENT
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
907804116
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$497.70 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Central Health Plan Commercial |
$442.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$497.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$351.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.27
|
| Rate for Payer: Multiplan Commercial |
$414.75
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
|
|
HC ED FAMILY THERAPY WITH PATIENT
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
907804116
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$87.72 |
| Max. Negotiated Rate |
$797.64 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$797.64
|
| 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 Exchange |
$267.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.68
|
| Rate for Payer: Blue Shield of California Commercial |
$350.60
|
| Rate for Payer: Blue Shield of California EPN |
$220.65
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Central Health Plan Commercial |
$442.40
|
| Rate for Payer: Cigna of CA HMO |
$353.92
|
| Rate for Payer: Cigna of CA PPO |
$409.22
|
| 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 |
$387.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$497.70
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$351.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$414.75
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
| Rate for Payer: Prime Health Services Medicare |
$241.99
|
| Rate for Payer: Riverside University Health System MISP |
$251.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.80
|
| 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 EDI CATH 12FRX125CM
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
900800873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$473.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$585.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$377.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.73
|
| Rate for Payer: Blue Shield of California Commercial |
$494.52
|
| Rate for Payer: Blue Shield of California EPN |
$311.22
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: Cigna of CA HMO |
$499.20
|
| Rate for Payer: Cigna of CA PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$663.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$663.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$663.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$546.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$495.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$460.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
| Rate for Payer: Riverside University Health System MISP |
$312.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.00
|
| Rate for Payer: United Healthcare All Other HMO |
$390.00
|
| Rate for Payer: United Healthcare HMO Rider |
$390.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.00
|
| Rate for Payer: Vantage Medical Group Senior |
$663.00
|
|
|
HC EDI CATH 12FRX125CM
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
900800873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$546.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$495.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$460.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC EDI CATH 6FRX49CM
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
900800870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$546.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$495.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$460.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC EDI CATH 6FRX49CM
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
900800870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$473.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$585.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$377.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.73
|
| Rate for Payer: Blue Shield of California Commercial |
$494.52
|
| Rate for Payer: Blue Shield of California EPN |
$311.22
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: Cigna of CA HMO |
$499.20
|
| Rate for Payer: Cigna of CA PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$663.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$663.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$663.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$546.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$495.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$460.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
| Rate for Payer: Riverside University Health System MISP |
$312.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.00
|
| Rate for Payer: United Healthcare All Other HMO |
$390.00
|
| Rate for Payer: United Healthcare HMO Rider |
$390.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.00
|
| Rate for Payer: Vantage Medical Group Senior |
$663.00
|
|
|
HC EDI CATH 6FRX50CM
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
900800871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$473.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$585.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$377.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.73
|
| Rate for Payer: Blue Shield of California Commercial |
$494.52
|
| Rate for Payer: Blue Shield of California EPN |
$311.22
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: Cigna of CA HMO |
$499.20
|
| Rate for Payer: Cigna of CA PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$663.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$663.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$663.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$546.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$495.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$460.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
| Rate for Payer: Riverside University Health System MISP |
$312.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.00
|
| Rate for Payer: United Healthcare All Other HMO |
$390.00
|
| Rate for Payer: United Healthcare HMO Rider |
$390.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.00
|
| Rate for Payer: Vantage Medical Group Senior |
$663.00
|
|
|
HC EDI CATH 6FRX50CM
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
900800871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$546.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$495.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$460.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC EDI CATH 8FRX100CM
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
900800872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$546.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$495.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$460.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC EDI CATH 8FRX100CM
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
900800872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$473.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$585.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$377.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.73
|
| Rate for Payer: Blue Shield of California Commercial |
$494.52
|
| Rate for Payer: Blue Shield of California EPN |
$311.22
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: Cigna of CA HMO |
$499.20
|
| Rate for Payer: Cigna of CA PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$663.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$663.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$663.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$546.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$495.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$460.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
| Rate for Payer: Riverside University Health System MISP |
$312.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.00
|
| Rate for Payer: United Healthcare All Other HMO |
$390.00
|
| Rate for Payer: United Healthcare HMO Rider |
$390.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.00
|
| Rate for Payer: Vantage Medical Group Senior |
$663.00
|
|
|
HC ED INDIV BRIEF THERAPY
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804117
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$464.17 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$464.17
|
| 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 Exchange |
$195.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.01
|
| Rate for Payer: Blue Shield of California Commercial |
$256.14
|
| Rate for Payer: Blue Shield of California EPN |
$161.20
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Central Health Plan Commercial |
$323.20
|
| Rate for Payer: Cigna of CA HMO |
$258.56
|
| Rate for Payer: Cigna of CA PPO |
$298.96
|
| 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 |
$282.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$363.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$303.00
|
| Rate for Payer: Networks By Design Commercial |
$262.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: Prime Health Services Medicare |
$241.99
|
| Rate for Payer: Riverside University Health System MISP |
$251.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.40
|
| 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 ED INDIV BRIEF THERAPY
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804117
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$363.60 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Central Health Plan Commercial |
$323.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$363.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.36
|
| Rate for Payer: Multiplan Commercial |
$303.00
|
| Rate for Payer: Networks By Design Commercial |
$262.60
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
|
|
HC ED INDIV THERAPY
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804118
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$674.93 |
| Rate for Payer: Adventist Health Commercial |
$102.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$674.93
|
| 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 Exchange |
$247.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$297.83
|
| Rate for Payer: Blue Shield of California Commercial |
$324.61
|
| Rate for Payer: Blue Shield of California EPN |
$204.29
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Central Health Plan Commercial |
$409.60
|
| Rate for Payer: Cigna of CA HMO |
$327.68
|
| Rate for Payer: Cigna of CA PPO |
$378.88
|
| 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 |
$358.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$307.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$460.80
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$325.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$332.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
| Rate for Payer: Prime Health Services Medicare |
$241.99
|
| Rate for Payer: Riverside University Health System MISP |
$251.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$307.20
|
| 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 ED INDIV THERAPY
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804118
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$460.80 |
| Rate for Payer: Adventist Health Commercial |
$102.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Central Health Plan Commercial |
$409.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$358.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.80
|
| Rate for Payer: EPIC Health Plan Senior |
$204.80
|
| Rate for Payer: Galaxy Health WC |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$307.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$460.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$325.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$302.08
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$332.80
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
|
|
HC ED INTENSIVE OUT (ADOL)
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907300015
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$385.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$463.03
|
| Rate for Payer: Blue Shield of California Commercial |
$504.66
|
| Rate for Payer: Blue Shield of California EPN |
$317.60
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Cigna of CA HMO |
$509.44
|
| Rate for Payer: Cigna of CA PPO |
$589.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.59
|
| Rate for Payer: EPIC Health Plan Senior |
$143.73
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$505.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.66
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Prime Health Services Medicare |
$138.50
|
| Rate for Payer: Riverside University Health System MISP |
$143.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC ED INTENSIVE OUT (ADOL)
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907300015
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$505.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.64
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
|
