|
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 |
$18,044.14
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$15,569.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,893.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,449.32
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.31
|
| 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 |
$610.00 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$204.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$335.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$267.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$324.78
|
| Rate for Payer: Blue Shield of California Commercial |
$337.88
|
| 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 |
$306.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Senior |
$204.15
|
| Rate for Payer: Galaxy Health WC |
$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 |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.15
|
| Rate for Payer: InnovAge PACE Commercial |
$306.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.56
|
| 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 |
$204.15
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
| Rate for Payer: Prime Health Services Medicare |
$216.40
|
| Rate for Payer: Riverside University Health System MISP |
$224.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.50
|
| Rate for Payer: United Healthcare All Other HMO |
$276.50
|
| Rate for Payer: United Healthcare HMO Rider |
$276.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$204.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Vantage Medical Group Senior |
$204.15
|
|
|
HC 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 |
$458.09
|
| Rate for Payer: Blue Shield of California Commercial |
$476.58
|
| 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: 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: InnovAge PACE Commercial |
$390.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$546.00
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| 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 |
$458.09
|
| Rate for Payer: Blue Shield of California Commercial |
$476.58
|
| 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: 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: InnovAge PACE Commercial |
$390.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$546.00
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| 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 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 |
$458.09
|
| Rate for Payer: Blue Shield of California Commercial |
$476.58
|
| 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: 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: InnovAge PACE Commercial |
$390.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$546.00
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| 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 |
$458.09
|
| Rate for Payer: Blue Shield of California Commercial |
$476.58
|
| 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: 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: InnovAge PACE Commercial |
$390.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$546.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$363.60 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$204.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$245.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$195.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.27
|
| Rate for Payer: Blue Shield of California Commercial |
$246.84
|
| 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 |
$306.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Senior |
$204.15
|
| Rate for Payer: Galaxy Health WC |
$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 |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.15
|
| Rate for Payer: InnovAge PACE Commercial |
$306.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$269.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.56
|
| 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 |
$204.15
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: Prime Health Services Medicare |
$216.40
|
| Rate for Payer: Riverside University Health System MISP |
$224.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.00
|
| Rate for Payer: United Healthcare All Other HMO |
$202.00
|
| Rate for Payer: United Healthcare HMO Rider |
$202.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$202.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$204.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Vantage Medical Group Senior |
$204.15
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$269.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.08
|
| 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 |
$610.00 |
| Rate for Payer: Adventist Health Commercial |
$102.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$204.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$310.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.70
|
| Rate for Payer: Blue Shield of California Commercial |
$312.83
|
| 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 |
$306.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Senior |
$204.15
|
| Rate for Payer: Galaxy Health WC |
$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 |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.15
|
| Rate for Payer: InnovAge PACE Commercial |
$306.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.56
|
| 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 |
$204.15
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
| Rate for Payer: Prime Health Services Medicare |
$216.40
|
| Rate for Payer: Riverside University Health System MISP |
$224.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$307.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.00
|
| Rate for Payer: United Healthcare All Other HMO |
$256.00
|
| Rate for Payer: United Healthcare HMO Rider |
$256.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$204.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Vantage Medical Group Senior |
$204.15
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$341.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.93
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| 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
|
|
|
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 |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$483.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$385.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$467.49
|
| Rate for Payer: Blue Shield of California Commercial |
$486.36
|
| 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 |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| 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 |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| 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 |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$398.00
|
| Rate for Payer: United Healthcare All Other HMO |
$398.00
|
| Rate for Payer: United Healthcare HMO Rider |
$398.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC ED INTERACTIVE GROUP THERAPY
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804101
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$88.60 |
| Max. Negotiated Rate |
$398.70 |
| Rate for Payer: Adventist Health Commercial |
$88.60
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Central Health Plan Commercial |
$354.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.20
|
| Rate for Payer: EPIC Health Plan Senior |
$177.20
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$398.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$295.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$274.22
|
| Rate for Payer: Multiplan Commercial |
$332.25
|
| Rate for Payer: Networks By Design Commercial |
$287.95
|
| Rate for Payer: Prime Health Services Commercial |
$376.55
|
|
|
HC ED INTERACTIVE GROUP THERAPY
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804101
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$88.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$269.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$214.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.17
|
| Rate for Payer: Blue Shield of California Commercial |
$270.67
|
| Rate for Payer: Blue Shield of California EPN |
$176.76
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Central Health Plan Commercial |
$354.40
|
| Rate for Payer: Cigna of CA HMO |
$283.52
|
| Rate for Payer: Cigna of CA PPO |
$327.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$398.70
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$295.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$332.25
|
| Rate for Payer: Networks By Design Commercial |
$287.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$376.55
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.50
|
| Rate for Payer: United Healthcare All Other HMO |
$221.50
|
| Rate for Payer: United Healthcare HMO Rider |
$221.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$221.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC ED MOLD SKT EXP INTERF FLEX HI
|
Facility
|
OP
|
$4,502.00
|
|
|
Service Code
|
CPT L6055
|
| Hospital Charge Code |
915356055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,474.40 |
| Max. Negotiated Rate |
$4,051.80 |
| Rate for Payer: Adventist Health Commercial |
$1,845.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,476.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,376.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,644.02
|
| Rate for Payer: Blue Shield of California Commercial |
$3,480.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,269.01
|
| Rate for Payer: Cash Price |
$2,025.90
|
| Rate for Payer: Cash Price |
$2,025.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,601.60
|
| Rate for Payer: Cigna of CA HMO |
$3,151.40
|
| Rate for Payer: Cigna of CA PPO |
$3,151.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,826.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,826.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.80
|
| Rate for Payer: Galaxy Health WC |
$3,826.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,701.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,051.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,559.41
|
| Rate for Payer: InnovAge PACE Commercial |
$2,251.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,827.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,786.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,845.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,151.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,151.40
|
| Rate for Payer: Multiplan Commercial |
$3,376.50
|
| Rate for Payer: Networks By Design Commercial |
$2,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,826.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,800.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,701.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,701.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,644.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,609.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,474.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,826.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,826.70
|
|
|
HC ED MOLD SKT EXP INTERF FLEX HI
|
Facility
|
IP
|
$4,502.00
|
|
|
Service Code
|
CPT L6055
|
| Hospital Charge Code |
905356055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$900.40 |
| Max. Negotiated Rate |
$4,051.80 |
| Rate for Payer: Adventist Health Commercial |
$900.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,480.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,269.01
|
| Rate for Payer: Cash Price |
$2,025.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,601.60
|
| Rate for Payer: Cigna of CA HMO |
$3,151.40
|
| Rate for Payer: Cigna of CA PPO |
$3,151.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.80
|
| Rate for Payer: Galaxy Health WC |
$3,826.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,701.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,051.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,715.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,786.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.40
|
| Rate for Payer: Multiplan Commercial |
$3,376.50
|
| Rate for Payer: Networks By Design Commercial |
$2,926.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,826.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,644.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,609.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,474.40
|
|
|
HC ED MOLD SKT EXP INTERF FLEX HI
|
Facility
|
IP
|
$4,502.00
|
|
|
Service Code
|
CPT L6055
|
| Hospital Charge Code |
915356055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$900.40 |
| Max. Negotiated Rate |
$4,051.80 |
| Rate for Payer: Adventist Health Commercial |
$900.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,480.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,269.01
|
| Rate for Payer: Cash Price |
$2,025.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,601.60
|
| Rate for Payer: Cigna of CA HMO |
$3,151.40
|
| Rate for Payer: Cigna of CA PPO |
$3,151.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.80
|
| Rate for Payer: Galaxy Health WC |
$3,826.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,701.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,051.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,715.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,786.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.40
|
| Rate for Payer: Multiplan Commercial |
$3,376.50
|
| Rate for Payer: Networks By Design Commercial |
$2,926.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,826.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,644.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,609.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,474.40
|
|
|
HC ED MOLD SKT EXP INTERF FLEX HI
|
Facility
|
OP
|
$4,502.00
|
|
|
Service Code
|
CPT L6055
|
| Hospital Charge Code |
905356055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,474.40 |
| Max. Negotiated Rate |
$4,051.80 |
| Rate for Payer: Adventist Health Commercial |
$1,845.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,476.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,376.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,644.02
|
| Rate for Payer: Blue Shield of California Commercial |
$3,480.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,269.01
|
| Rate for Payer: Cash Price |
$2,025.90
|
| Rate for Payer: Cash Price |
$2,025.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,601.60
|
| Rate for Payer: Cigna of CA HMO |
$3,151.40
|
| Rate for Payer: Cigna of CA PPO |
$3,151.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,826.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,826.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.80
|
| Rate for Payer: Galaxy Health WC |
$3,826.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,701.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,051.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,559.41
|
| Rate for Payer: InnovAge PACE Commercial |
$2,251.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,827.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,786.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,845.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,151.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,151.40
|
| Rate for Payer: Multiplan Commercial |
$3,376.50
|
| Rate for Payer: Networks By Design Commercial |
$2,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,826.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,800.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,701.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,701.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,644.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,609.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,474.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,826.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,826.70
|
|
|
HC ED MOLD SKT FLEX HING TRICEPS
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
CPT L6050
|
| Hospital Charge Code |
905356050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$424.00 |
| Max. Negotiated Rate |
$1,908.00 |
| Rate for Payer: Adventist Health Commercial |
$424.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,638.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,068.48
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,696.00
|
| Rate for Payer: Cigna of CA HMO |
$1,484.00
|
| Rate for Payer: Cigna of CA PPO |
$1,484.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Senior |
$848.00
|
| Rate for Payer: Galaxy Health WC |
$1,802.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,908.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,312.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.00
|
| Rate for Payer: Multiplan Commercial |
$1,590.00
|
| Rate for Payer: Networks By Design Commercial |
$1,378.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$795.64
|
| Rate for Payer: United Healthcare All Other HMO |
$774.44
|
| Rate for Payer: United Healthcare HMO Rider |
$757.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$694.30
|
|
|
HC ED MOLD SKT FLEX HING TRICEPS
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
CPT L6050
|
| Hospital Charge Code |
905356050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$694.30 |
| Max. Negotiated Rate |
$1,908.00 |
| Rate for Payer: Adventist Health Commercial |
$869.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,166.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,590.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,245.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,638.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,068.48
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,696.00
|
| Rate for Payer: Cigna of CA HMO |
$1,484.00
|
| Rate for Payer: Cigna of CA PPO |
$1,484.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,802.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,802.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Senior |
$848.00
|
| Rate for Payer: Galaxy Health WC |
$1,802.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,908.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,386.30
|
| Rate for Payer: InnovAge PACE Commercial |
$1,060.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,531.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,312.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,484.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,484.00
|
| Rate for Payer: Multiplan Commercial |
$1,590.00
|
| Rate for Payer: Networks By Design Commercial |
$1,060.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.00
|
| Rate for Payer: Riverside University Health System MISP |
$848.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,272.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,272.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$795.64
|
| Rate for Payer: United Healthcare All Other HMO |
$774.44
|
| Rate for Payer: United Healthcare HMO Rider |
$757.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$694.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,802.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,802.00
|
|
