|
HC HLTH BHV ASSMT/REASSMT
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
902506156
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$117.53 |
| Max. Negotiated Rate |
$1,570.00 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$359.52
|
| 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 |
$286.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.68
|
| Rate for Payer: Blue Shield of California Commercial |
$361.71
|
| Rate for Payer: Blue Shield of California EPN |
$236.21
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Central Health Plan Commercial |
$473.60
|
| Rate for Payer: Cigna of CA HMO |
$378.88
|
| Rate for Payer: Cigna of CA PPO |
$438.08
|
| 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 |
$503.20
|
| Rate for Payer: Global Benefits Group Commercial |
$355.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$532.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$146.89
|
| 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 |
$394.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.40
|
| 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 |
$444.00
|
| Rate for Payer: Networks By Design Commercial |
$384.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$503.20
|
| 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 |
$355.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$355.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,496.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,129.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| 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 HLTH BHV INTV FMLY W/PT 30 MIN
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 96167
|
| Hospital Charge Code |
902506167
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC HLTH BHV INTV FMLY W/PT 30 MIN
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 96167
|
| Hospital Charge Code |
902506167
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$117.48 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.08
|
| Rate for Payer: Blue Shield of California Commercial |
$63.54
|
| Rate for Payer: Blue Shield of California EPN |
$41.50
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.10
|
| Rate for Payer: EPIC Health Plan Senior |
$37.85
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$62.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.85
|
| Rate for Payer: InnovAge PACE Commercial |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.72
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.85
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Medicare |
$40.12
|
| Rate for Payer: Riverside University Health System MISP |
$41.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.00
|
| Rate for Payer: United Healthcare All Other HMO |
$52.00
|
| Rate for Payer: United Healthcare HMO Rider |
$52.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Vantage Medical Group Senior |
$37.85
|
|
|
HC HLTH BHV INTV IND EA ADD 15MIN
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
902506159
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.64
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC HLTH BHV INTV IND EA ADD 15MIN
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
902506159
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$341.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$220.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.22
|
| Rate for Payer: Blue Shield of California Commercial |
$278.00
|
| Rate for Payer: Blue Shield of California EPN |
$181.54
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.59
|
| Rate for Payer: InnovAge PACE Commercial |
$227.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.50
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Riverside University Health System MISP |
$182.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.50
|
| Rate for Payer: United Healthcare All Other HMO |
$227.50
|
| Rate for Payer: United Healthcare HMO Rider |
$227.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC HLTH BHV INTVN GR EA ADD 15MIN
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 96165
|
| Hospital Charge Code |
902506165
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.64
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC HLTH BHV INTVN GR EA ADD 15MIN
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 96165
|
| Hospital Charge Code |
902506165
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$341.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$220.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.22
|
| Rate for Payer: Blue Shield of California Commercial |
$278.00
|
| Rate for Payer: Blue Shield of California EPN |
$181.54
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.72
|
| Rate for Payer: InnovAge PACE Commercial |
$227.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.50
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Riverside University Health System MISP |
$182.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.50
|
| Rate for Payer: United Healthcare All Other HMO |
$227.50
|
| Rate for Payer: United Healthcare HMO Rider |
$227.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC HLTH BHV INTVN GRP 1ST 30 MIN
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT 96164
|
| Hospital Charge Code |
902506164
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$817.20 |
| Rate for Payer: Adventist Health Commercial |
$181.60
|
| Rate for Payer: Cash Price |
$499.40
|
| Rate for Payer: Central Health Plan Commercial |
$726.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.20
|
| Rate for Payer: EPIC Health Plan Senior |
$363.20
|
| Rate for Payer: Galaxy Health WC |
$771.80
|
| Rate for Payer: Global Benefits Group Commercial |
$544.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$817.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$605.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$562.05
|
| Rate for Payer: Multiplan Commercial |
$681.00
|
| Rate for Payer: Networks By Design Commercial |
$590.20
|
| Rate for Payer: Prime Health Services Commercial |
$771.80
|
|
|
HC HLTH BHV INTVN GRP 1ST 30 MIN
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT 96164
|
| Hospital Charge Code |
902506164
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$817.20 |
| Rate for Payer: Adventist Health Commercial |
$181.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$551.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$439.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$533.27
|
| Rate for Payer: Blue Shield of California Commercial |
$554.79
|
| Rate for Payer: Blue Shield of California EPN |
$362.29
|
| Rate for Payer: Cash Price |
$499.40
|
| Rate for Payer: Cash Price |
$499.40
|
| Rate for Payer: Central Health Plan Commercial |
$726.40
|
| Rate for Payer: Cigna of CA HMO |
$581.12
|
| Rate for Payer: Cigna of CA PPO |
$671.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.10
|
| Rate for Payer: EPIC Health Plan Senior |
$37.85
|
| Rate for Payer: Galaxy Health WC |
$771.80
|
| Rate for Payer: Global Benefits Group Commercial |
$544.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$817.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$62.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.85
|
| Rate for Payer: InnovAge PACE Commercial |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$605.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.72
|
| Rate for Payer: Multiplan Commercial |
$681.00
|
| Rate for Payer: Networks By Design Commercial |
$590.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.85
|
| Rate for Payer: Prime Health Services Commercial |
$771.80
|
| Rate for Payer: Prime Health Services Medicare |
$40.12
|
| Rate for Payer: Riverside University Health System MISP |
$41.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$544.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$544.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$454.00
|
| Rate for Payer: United Healthcare All Other HMO |
$454.00
|
| Rate for Payer: United Healthcare HMO Rider |
$454.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$454.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Vantage Medical Group Senior |
$37.85
|
|
|
HC HLTH BHV INTVN INDIV 1ST 30MIN
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
902506158
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$81.61 |
| Max. Negotiated Rate |
$817.20 |
| Rate for Payer: Adventist Health Commercial |
$181.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$204.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$551.43
|
| 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 |
$439.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$533.27
|
| Rate for Payer: Blue Shield of California Commercial |
$554.79
|
| Rate for Payer: Blue Shield of California EPN |
$362.29
|
| Rate for Payer: Cash Price |
$499.40
|
| Rate for Payer: Cash Price |
$499.40
|
| Rate for Payer: Central Health Plan Commercial |
$726.40
|
| Rate for Payer: Cigna of CA HMO |
$581.12
|
| Rate for Payer: Cigna of CA PPO |
$671.92
|
| 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 |
$771.80
|
| Rate for Payer: Global Benefits Group Commercial |
$544.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$817.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.61
|
| 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 |
$605.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.16
|
| 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 |
$681.00
|
| Rate for Payer: Networks By Design Commercial |
$590.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$204.15
|
| Rate for Payer: Prime Health Services Commercial |
$771.80
|
| 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 |
$544.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$544.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$454.00
|
| Rate for Payer: United Healthcare All Other HMO |
$454.00
|
| Rate for Payer: United Healthcare HMO Rider |
$454.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$454.00
|
| 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 HLTH BHV INTVN INDIV 1ST 30MIN
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
902506158
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$817.20 |
| Rate for Payer: Adventist Health Commercial |
$181.60
|
| Rate for Payer: Cash Price |
$499.40
|
| Rate for Payer: Central Health Plan Commercial |
$726.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.20
|
| Rate for Payer: EPIC Health Plan Senior |
$363.20
|
| Rate for Payer: Galaxy Health WC |
$771.80
|
| Rate for Payer: Global Benefits Group Commercial |
$544.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$817.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$605.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$562.05
|
| Rate for Payer: Multiplan Commercial |
$681.00
|
| Rate for Payer: Networks By Design Commercial |
$590.20
|
| Rate for Payer: Prime Health Services Commercial |
$771.80
|
|
|
HC HLTH BV INT FMY W/PT ADD 15 MN
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 96168
|
| Hospital Charge Code |
902506168
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.20
|
| Rate for Payer: EPIC Health Plan Senior |
$21.20
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.81
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
|
|
HC HLTH BV INT FMY W/PT ADD 15 MN
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 96168
|
| Hospital Charge Code |
902506168
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.13
|
| Rate for Payer: Blue Shield of California Commercial |
$32.38
|
| Rate for Payer: Blue Shield of California EPN |
$21.15
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: Cigna of CA HMO |
$33.92
|
| Rate for Payer: Cigna of CA PPO |
$39.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.20
|
| Rate for Payer: EPIC Health Plan Senior |
$21.20
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.74
|
| Rate for Payer: InnovAge PACE Commercial |
$26.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.10
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
| Rate for Payer: Riverside University Health System MISP |
$21.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.50
|
| Rate for Payer: United Healthcare All Other HMO |
$26.50
|
| Rate for Payer: United Healthcare HMO Rider |
$26.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.05
|
| Rate for Payer: Vantage Medical Group Senior |
$45.05
|
|
|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
905351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Adventist Health Commercial |
$72.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.95
|
| Rate for Payer: Blue Shield of California Commercial |
$136.82
|
| Rate for Payer: Blue Shield of California EPN |
$89.21
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Central Health Plan Commercial |
$141.60
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.04
|
| Rate for Payer: InnovAge PACE Commercial |
$88.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.90
|
| Rate for Payer: Multiplan Commercial |
$132.75
|
| Rate for Payer: Networks By Design Commercial |
$88.50
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: Riverside University Health System MISP |
$70.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.43
|
| Rate for Payer: United Healthcare All Other HMO |
$64.66
|
| Rate for Payer: United Healthcare HMO Rider |
$63.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.45
|
| Rate for Payer: Vantage Medical Group Senior |
$150.45
|
|
|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
915351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Adventist Health Commercial |
$72.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.95
|
| Rate for Payer: Blue Shield of California Commercial |
$136.82
|
| Rate for Payer: Blue Shield of California EPN |
$89.21
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Central Health Plan Commercial |
$141.60
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.04
|
| Rate for Payer: InnovAge PACE Commercial |
$88.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.90
|
| Rate for Payer: Multiplan Commercial |
$132.75
|
| Rate for Payer: Networks By Design Commercial |
$88.50
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: Riverside University Health System MISP |
$70.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.43
|
| Rate for Payer: United Healthcare All Other HMO |
$64.66
|
| Rate for Payer: United Healthcare HMO Rider |
$63.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.45
|
| Rate for Payer: Vantage Medical Group Senior |
$150.45
|
|
|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
905351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Blue Shield of California Commercial |
$136.82
|
| Rate for Payer: Blue Shield of California EPN |
$89.21
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Central Health Plan Commercial |
$141.60
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.40
|
| Rate for Payer: Multiplan Commercial |
$132.75
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.43
|
| Rate for Payer: United Healthcare All Other HMO |
$64.66
|
| Rate for Payer: United Healthcare HMO Rider |
$63.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.97
|
|
|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
915351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Blue Shield of California Commercial |
$136.82
|
| Rate for Payer: Blue Shield of California EPN |
$89.21
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Central Health Plan Commercial |
$141.60
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.40
|
| Rate for Payer: Multiplan Commercial |
$132.75
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.43
|
| Rate for Payer: United Healthcare All Other HMO |
$64.66
|
| Rate for Payer: United Healthcare HMO Rider |
$63.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.97
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
915351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.19
|
| Rate for Payer: Blue Shield of California Commercial |
$231.90
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.09
|
| Rate for Payer: InnovAge PACE Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health System MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
915351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$231.90
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
905351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.21 |
| Max. Negotiated Rate |
$141.49 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.29
|
| Rate for Payer: Blue Shield of California Commercial |
$104.36
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.09
|
| Rate for Payer: InnovAge PACE Commercial |
$67.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Riverside University Health System MISP |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
905351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$104.36
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
905351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Blue Shield of California Commercial |
$347.08
|
| Rate for Payer: Blue Shield of California EPN |
$226.30
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Central Health Plan Commercial |
$359.20
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$404.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.80
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
905351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.05 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Adventist Health Commercial |
$184.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.70
|
| Rate for Payer: Blue Shield of California Commercial |
$347.08
|
| Rate for Payer: Blue Shield of California EPN |
$226.30
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Central Health Plan Commercial |
$359.20
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$381.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$381.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$404.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$265.91
|
| Rate for Payer: InnovAge PACE Commercial |
$224.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$314.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$314.30
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Riverside University Health System MISP |
$179.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$381.65
|
| Rate for Payer: Vantage Medical Group Senior |
$381.65
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
915351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.05 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Adventist Health Commercial |
$184.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.70
|
| Rate for Payer: Blue Shield of California Commercial |
$347.08
|
| Rate for Payer: Blue Shield of California EPN |
$226.30
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Central Health Plan Commercial |
$359.20
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$381.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$381.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$404.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$265.91
|
| Rate for Payer: InnovAge PACE Commercial |
$224.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$314.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$314.30
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Riverside University Health System MISP |
$179.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$381.65
|
| Rate for Payer: Vantage Medical Group Senior |
$381.65
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
915351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Blue Shield of California Commercial |
$347.08
|
| Rate for Payer: Blue Shield of California EPN |
$226.30
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Central Health Plan Commercial |
$359.20
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$404.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.80
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
|
