|
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 |
$437.80
|
| 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 |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| 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 |
$243.65
|
| 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 |
$243.65
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cash Price |
$243.65
|
| 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
|
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 |
$2,476.10
|
| 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 |
$2,476.10
|
| Rate for Payer: Cash Price |
$2,476.10
|
| 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 |
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 |
$2,476.10
|
| 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 |
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 |
$2,476.10
|
| Rate for Payer: Cash Price |
$2,476.10
|
| 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
|
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 |
$1,166.00
|
| Rate for Payer: Cash Price |
$1,166.00
|
| 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
|
|
|
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 |
$1,166.00
|
| 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
|
IP
|
$4,696.00
|
|
|
Service Code
|
CPT L6050
|
| Hospital Charge Code |
915356050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$939.20 |
| Max. Negotiated Rate |
$4,226.40 |
| Rate for Payer: Adventist Health Commercial |
$939.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,630.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,366.78
|
| Rate for Payer: Cash Price |
$2,582.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,756.80
|
| Rate for Payer: Cigna of CA HMO |
$3,287.20
|
| Rate for Payer: Cigna of CA PPO |
$3,287.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,878.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,878.40
|
| Rate for Payer: Galaxy Health WC |
$3,991.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,817.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,226.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,132.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,789.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,906.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$939.20
|
| Rate for Payer: Multiplan Commercial |
$3,522.00
|
| Rate for Payer: Networks By Design Commercial |
$3,052.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,991.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,762.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,715.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,678.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,537.94
|
|
|
HC ED MOLD SKT FLEX HING TRICEPS
|
Facility
|
OP
|
$4,696.00
|
|
|
Service Code
|
CPT L6050
|
| Hospital Charge Code |
915356050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,386.30 |
| Max. Negotiated Rate |
$4,226.40 |
| Rate for Payer: Adventist Health Commercial |
$1,925.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,991.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,582.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,522.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,757.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3,630.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,366.78
|
| Rate for Payer: Cash Price |
$2,582.80
|
| Rate for Payer: Cash Price |
$2,582.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,756.80
|
| Rate for Payer: Cigna of CA HMO |
$3,287.20
|
| Rate for Payer: Cigna of CA PPO |
$3,287.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,991.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,991.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,991.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,878.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,878.40
|
| Rate for Payer: Galaxy Health WC |
$3,991.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,817.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,226.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,386.30
|
| Rate for Payer: InnovAge PACE Commercial |
$2,348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,132.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,531.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,906.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,925.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,287.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,287.20
|
| Rate for Payer: Multiplan Commercial |
$3,522.00
|
| Rate for Payer: Networks By Design Commercial |
$2,348.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,991.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,878.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,817.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,817.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,762.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,715.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,678.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,537.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,991.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,991.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,991.60
|
|
|
HC ED MOLD SKT OUTSIDE LOCKNG HNG
|
Facility
|
IP
|
$6,661.00
|
|
|
Service Code
|
CPT L6200
|
| Hospital Charge Code |
905356200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,332.20 |
| Max. Negotiated Rate |
$5,994.90 |
| Rate for Payer: Adventist Health Commercial |
$1,332.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,148.95
|
| Rate for Payer: Blue Shield of California EPN |
$3,357.14
|
| Rate for Payer: Cash Price |
$3,663.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,328.80
|
| Rate for Payer: Cigna of CA HMO |
$4,662.70
|
| Rate for Payer: Cigna of CA PPO |
$4,662.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.40
|
| Rate for Payer: Galaxy Health WC |
$5,661.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,994.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,442.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,537.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.20
|
| Rate for Payer: Multiplan Commercial |
$4,995.75
|
| Rate for Payer: Networks By Design Commercial |
$4,329.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,433.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,181.48
|
|
|
HC ED MOLD SKT OUTSIDE LOCKNG HNG
|
Facility
|
OP
|
$6,661.00
|
|
|
Service Code
|
CPT L6200
|
| Hospital Charge Code |
905356200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,964.12 |
| Max. Negotiated Rate |
$5,994.90 |
| Rate for Payer: Adventist Health Commercial |
$2,731.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,663.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,995.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,912.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5,148.95
|
| Rate for Payer: Blue Shield of California EPN |
$3,357.14
|
| Rate for Payer: Cash Price |
$3,663.55
|
| Rate for Payer: Cash Price |
$3,663.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,328.80
|
| Rate for Payer: Cigna of CA HMO |
$4,662.70
|
| Rate for Payer: Cigna of CA PPO |
$4,662.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,661.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,661.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.40
|
| Rate for Payer: Galaxy Health WC |
$5,661.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,994.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,964.12
|
| Rate for Payer: InnovAge PACE Commercial |
$3,330.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,442.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,731.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,662.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,662.70
|
| Rate for Payer: Multiplan Commercial |
$4,995.75
|
| Rate for Payer: Networks By Design Commercial |
$3,330.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,664.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,996.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,996.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,433.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,181.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,661.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5,661.85
|
|
|
HC ED MOLD SKT OUTSIDE LOCKNG HNG
|
Facility
|
IP
|
$6,661.00
|
|
|
Service Code
|
CPT L6200
|
| Hospital Charge Code |
915356200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,332.20 |
| Max. Negotiated Rate |
$5,994.90 |
| Rate for Payer: Adventist Health Commercial |
$1,332.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,148.95
|
| Rate for Payer: Blue Shield of California EPN |
$3,357.14
|
| Rate for Payer: Cash Price |
$3,663.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,328.80
|
| Rate for Payer: Cigna of CA HMO |
$4,662.70
|
| Rate for Payer: Cigna of CA PPO |
$4,662.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.40
|
| Rate for Payer: Galaxy Health WC |
$5,661.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,994.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,442.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,537.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.20
|
| Rate for Payer: Multiplan Commercial |
$4,995.75
|
| Rate for Payer: Networks By Design Commercial |
$4,329.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,433.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,181.48
|
|
|
HC ED MOLD SKT OUTSIDE LOCKNG HNG
|
Facility
|
OP
|
$6,661.00
|
|
|
Service Code
|
CPT L6200
|
| Hospital Charge Code |
915356200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,964.12 |
| Max. Negotiated Rate |
$5,994.90 |
| Rate for Payer: Adventist Health Commercial |
$2,731.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,663.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,995.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,912.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5,148.95
|
| Rate for Payer: Blue Shield of California EPN |
$3,357.14
|
| Rate for Payer: Cash Price |
$3,663.55
|
| Rate for Payer: Cash Price |
$3,663.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,328.80
|
| Rate for Payer: Cigna of CA HMO |
$4,662.70
|
| Rate for Payer: Cigna of CA PPO |
$4,662.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,661.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,661.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.40
|
| Rate for Payer: Galaxy Health WC |
$5,661.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,994.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,964.12
|
| Rate for Payer: InnovAge PACE Commercial |
$3,330.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,442.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,731.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,662.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,662.70
|
| Rate for Payer: Multiplan Commercial |
$4,995.75
|
| Rate for Payer: Networks By Design Commercial |
$3,330.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,664.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,996.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,996.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,433.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,181.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,661.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5,661.85
|
|
|
HC ED OT TASK GROUP
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804115
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$218.02
|
| 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 |
$173.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$210.84
|
| Rate for Payer: Blue Shield of California Commercial |
$219.35
|
| Rate for Payer: Blue Shield of California EPN |
$143.24
|
| Rate for Payer: Cash Price |
$197.45
|
| Rate for Payer: Cash Price |
$197.45
|
| Rate for Payer: Cash Price |
$197.45
|
| Rate for Payer: Central Health Plan Commercial |
$287.20
|
| Rate for Payer: Cigna of CA HMO |
$229.76
|
| Rate for Payer: Cigna of CA PPO |
$265.66
|
| 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 |
$305.15
|
| Rate for Payer: Global Benefits Group Commercial |
$215.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$323.10
|
| 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 |
$239.45
|
| 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 |
$269.25
|
| Rate for Payer: Networks By Design Commercial |
$233.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$305.15
|
| 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 |
$215.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$215.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.50
|
| Rate for Payer: United Healthcare All Other HMO |
$179.50
|
| Rate for Payer: United Healthcare HMO Rider |
$179.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$179.50
|
| 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 OT TASK GROUP
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804115
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$323.10 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Cash Price |
$197.45
|
| Rate for Payer: Central Health Plan Commercial |
$287.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$143.60
|
| Rate for Payer: Galaxy Health WC |
$305.15
|
| Rate for Payer: Global Benefits Group Commercial |
$215.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$323.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$239.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$222.22
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
| Rate for Payer: Networks By Design Commercial |
$233.35
|
| Rate for Payer: Prime Health Services Commercial |
$305.15
|
|
|
HC EDUCATION ED MENTAL HEALTH
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$157.85
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$233.81
|
| 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 |
$186.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.11
|
| Rate for Payer: Blue Shield of California Commercial |
$235.24
|
| Rate for Payer: Blue Shield of California EPN |
$153.62
|
| Rate for Payer: Cash Price |
$211.75
|
| Rate for Payer: Cash Price |
$211.75
|
| Rate for Payer: Cash Price |
$211.75
|
| Rate for Payer: Central Health Plan Commercial |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$246.40
|
| Rate for Payer: Cigna of CA PPO |
$284.90
|
| 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 |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.50
|
| 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 |
$256.80
|
| 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: LLUH Dept of Risk Management WC |
$77.00
|
| 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 |
$288.75
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| 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 |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| 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 EDUCATION ED MENTAL HEALTH
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Cash Price |
$211.75
|
| Rate for Payer: Central Health Plan Commercial |
$308.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Senior |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
|
|
HC EDUCATION MENTAL HEALTH
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804065
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.13
|
| 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 |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.65
|
| Rate for Payer: Blue Shield of California Commercial |
$228.51
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| 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 |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| 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 |
$249.46
|
| 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 |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| 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 |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.00
|
| Rate for Payer: United Healthcare All Other HMO |
$187.00
|
| Rate for Payer: United Healthcare HMO Rider |
$187.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.00
|
| 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 EDUCATION MENTAL HEALTH
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804065
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.51
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC EEG,AWAKE/DROWSY
|
Facility
|
OP
|
$2,957.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
900600228
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$2,661.30 |
| Rate for Payer: Adventist Health Commercial |
$591.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,795.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$444.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,736.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,794.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,173.93
|
| Rate for Payer: Cash Price |
$1,626.35
|
| Rate for Payer: Cash Price |
$1,626.35
|
| Rate for Payer: Cash Price |
$1,626.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,365.60
|
| Rate for Payer: Cigna of CA HMO |
$1,892.48
|
| Rate for Payer: Cigna of CA PPO |
$2,188.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$2,513.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,774.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,661.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,972.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$591.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$2,217.75
|
| Rate for Payer: Networks By Design Commercial |
$1,922.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$2,513.45
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,774.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,774.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC EEG,AWAKE/DROWSY
|
Facility
|
IP
|
$2,957.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
900600228
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$591.40 |
| Max. Negotiated Rate |
$2,661.30 |
| Rate for Payer: Adventist Health Commercial |
$591.40
|
| Rate for Payer: Cash Price |
$1,626.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,365.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,182.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,182.80
|
| Rate for Payer: Galaxy Health WC |
$2,513.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,774.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,661.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,972.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,126.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,830.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$591.40
|
| Rate for Payer: Multiplan Commercial |
$2,217.75
|
| Rate for Payer: Networks By Design Commercial |
$1,922.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,513.45
|
|
|
HC EEG AWAKE SLEEP
|
Facility
|
OP
|
$4,391.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
900600227
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$111.82 |
| Max. Negotiated Rate |
$3,951.90 |
| Rate for Payer: Adventist Health Commercial |
$878.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,666.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$361.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,578.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2,665.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,743.23
|
| Rate for Payer: Cash Price |
$2,415.05
|
| Rate for Payer: Cash Price |
$2,415.05
|
| Rate for Payer: Cash Price |
$2,415.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,512.80
|
| Rate for Payer: Cigna of CA HMO |
$2,810.24
|
| Rate for Payer: Cigna of CA PPO |
$3,249.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$3,732.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,634.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,951.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$111.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,928.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$3,293.25
|
| Rate for Payer: Networks By Design Commercial |
$2,854.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$3,732.35
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,634.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,634.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
