|
HC EDI CATH 6FRX49CM
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
900800870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC EDI CATH 6FRX49CM
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
900800870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$473.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$429.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$377.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.82
|
| Rate for Payer: Blue Distinction Transplant |
$468.00
|
| Rate for Payer: Blue Shield of California Commercial |
$490.62
|
| Rate for Payer: Blue Shield of California EPN |
$381.42
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: Cigna of CA HMO |
$499.20
|
| Rate for Payer: Cigna of CA PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$663.00
|
| Rate for Payer: Dignity Health Media |
$663.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$663.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$585.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$273.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
| Rate for Payer: Riverside University Health System MISP |
$312.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.00
|
| Rate for Payer: United Healthcare All Other HMO |
$390.00
|
| Rate for Payer: United Healthcare HMO Rider |
$390.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.00
|
| Rate for Payer: Vantage Medical Group Senior |
$663.00
|
|
|
HC EDI CATH 6FRX50CM
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
900800871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$473.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$429.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$377.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.82
|
| Rate for Payer: Blue Distinction Transplant |
$468.00
|
| Rate for Payer: Blue Shield of California Commercial |
$490.62
|
| Rate for Payer: Blue Shield of California EPN |
$381.42
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: Cigna of CA HMO |
$499.20
|
| Rate for Payer: Cigna of CA PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$663.00
|
| Rate for Payer: Dignity Health Media |
$663.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$663.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$585.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$273.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
| Rate for Payer: Riverside University Health System MISP |
$312.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.00
|
| Rate for Payer: United Healthcare All Other HMO |
$390.00
|
| Rate for Payer: United Healthcare HMO Rider |
$390.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.00
|
| Rate for Payer: Vantage Medical Group Senior |
$663.00
|
|
|
HC EDI CATH 6FRX50CM
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
900800871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC EDI CATH 8FRX100CM
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
900800872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC EDI CATH 8FRX100CM
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
900800872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$473.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$429.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$377.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.82
|
| Rate for Payer: Blue Distinction Transplant |
$468.00
|
| Rate for Payer: Blue Shield of California Commercial |
$490.62
|
| Rate for Payer: Blue Shield of California EPN |
$381.42
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Central Health Plan Commercial |
$624.00
|
| Rate for Payer: Cigna of CA HMO |
$499.20
|
| Rate for Payer: Cigna of CA PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$663.00
|
| Rate for Payer: Dignity Health Media |
$663.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$663.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$585.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$273.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$585.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
| Rate for Payer: Riverside University Health System MISP |
$312.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.00
|
| Rate for Payer: United Healthcare All Other HMO |
$390.00
|
| Rate for Payer: United Healthcare HMO Rider |
$390.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.00
|
| Rate for Payer: Vantage Medical Group Senior |
$663.00
|
|
|
HC ED INDIV BRIEF THERAPY
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804117
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$460.18 |
| Rate for Payer: Adventist Health Medi-Cal |
$199.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$460.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$162.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.92
|
| Rate for Payer: Blue Distinction Transplant |
$201.00
|
| Rate for Payer: Blue Shield of California Commercial |
$210.72
|
| Rate for Payer: Blue Shield of California EPN |
$163.82
|
| Rate for Payer: Caremore Medicare Advantage |
$199.21
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: Cigna of CA HMO |
$214.40
|
| Rate for Payer: Cigna of CA PPO |
$247.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.82
|
| Rate for Payer: Dignity Health Media |
$199.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$199.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.21
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$251.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$328.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$199.21
|
| Rate for Payer: InnovAge PACE Commercial |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$223.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.94
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
| Rate for Payer: Prime Health Services Medicare |
$211.16
|
| Rate for Payer: Riverside University Health System MISP |
$219.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.50
|
| Rate for Payer: United Healthcare All Other HMO |
$167.50
|
| Rate for Payer: United Healthcare HMO Rider |
$167.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$167.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Vantage Medical Group Senior |
$199.21
|
|
|
HC ED INDIV BRIEF THERAPY
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804117
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.00
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$223.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
|
|
HC ED INDIV THERAPY
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804118
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Central Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.00
|
| Rate for Payer: Galaxy Health WC |
$361.25
|
| Rate for Payer: Global Benefits Group Commercial |
$255.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$382.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.00
|
| Rate for Payer: Multiplan Commercial |
$318.75
|
| Rate for Payer: Networks By Design Commercial |
$276.25
|
| Rate for Payer: Prime Health Services Commercial |
$361.25
|
|
|
HC ED INDIV THERAPY
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804118
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$674.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$199.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$674.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$205.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.09
|
| Rate for Payer: Blue Distinction Transplant |
$255.00
|
| Rate for Payer: Blue Shield of California Commercial |
$267.32
|
| Rate for Payer: Blue Shield of California EPN |
$207.82
|
| Rate for Payer: Caremore Medicare Advantage |
$199.21
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Cash Price |
$191.25
|
| Rate for Payer: Central Health Plan Commercial |
$340.00
|
| Rate for Payer: Cigna of CA HMO |
$272.00
|
| Rate for Payer: Cigna of CA PPO |
$314.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.82
|
| Rate for Payer: Dignity Health Media |
$199.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$199.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.21
|
| Rate for Payer: Galaxy Health WC |
$361.25
|
| Rate for Payer: Global Benefits Group Commercial |
$255.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$382.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$318.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$328.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$199.21
|
| Rate for Payer: InnovAge PACE Commercial |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.00
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$610.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.94
|
| Rate for Payer: Multiplan Commercial |
$318.75
|
| Rate for Payer: Networks By Design Commercial |
$276.25
|
| Rate for Payer: Prime Health Services Commercial |
$361.25
|
| Rate for Payer: Prime Health Services Medicare |
$211.16
|
| Rate for Payer: Riverside University Health System MISP |
$219.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$255.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other HMO |
$212.50
|
| Rate for Payer: United Healthcare HMO Rider |
$212.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$212.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Vantage Medical Group Senior |
$199.21
|
|
|
HC ED INTENSIVE OUT (ADOL)
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907300015
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$464.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$567.17
|
| Rate for Payer: Blue Distinction Transplant |
$576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$603.84
|
| Rate for Payer: Blue Shield of California EPN |
$469.44
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Central Health Plan Commercial |
$768.00
|
| Rate for Payer: Cigna of CA HMO |
$614.40
|
| Rate for Payer: Cigna of CA PPO |
$710.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$816.00
|
| Rate for Payer: Global Benefits Group Commercial |
$576.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$720.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.00
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$610.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Networks By Design Commercial |
$624.00
|
| Rate for Payer: Prime Health Services Commercial |
$816.00
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$576.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$576.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Other HMO |
$480.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$480.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC ED INTENSIVE OUT (ADOL)
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907300015
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Central Health Plan Commercial |
$768.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.00
|
| Rate for Payer: Galaxy Health WC |
$816.00
|
| Rate for Payer: Global Benefits Group Commercial |
$576.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Networks By Design Commercial |
$624.00
|
| Rate for Payer: Prime Health Services Commercial |
$816.00
|
|
|
HC ED INTERACTIVE GROUP THERAPY
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804101
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$162.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.92
|
| Rate for Payer: Blue Distinction Transplant |
$201.00
|
| Rate for Payer: Blue Shield of California Commercial |
$210.72
|
| Rate for Payer: Blue Shield of California EPN |
$163.82
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: Cigna of CA HMO |
$214.40
|
| Rate for Payer: Cigna of CA PPO |
$247.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$251.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$223.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.50
|
| Rate for Payer: United Healthcare All Other HMO |
$167.50
|
| Rate for Payer: United Healthcare HMO Rider |
$167.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$167.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC ED INTERACTIVE GROUP THERAPY
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804101
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.00
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$223.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
|
|
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 |
$1,575.70 |
| Max. Negotiated Rate |
$4,051.80 |
| 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 |
$2,476.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,179.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,659.78
|
| Rate for Payer: Blue Distinction Transplant |
$2,701.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,376.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,449.09
|
| Rate for Payer: Cash Price |
$2,025.90
|
| Rate for Payer: Cash Price |
$2,025.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,601.60
|
| Rate for Payer: Cigna of CA HMO |
$3,151.40
|
| Rate for Payer: Cigna of CA PPO |
$3,151.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Dignity Health Media |
$3,826.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,826.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$3,376.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,575.70
|
| 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: LLUH Dept of Risk Management WC |
$1,845.82
|
| 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 |
$2,251.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,251.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,251.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,251.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,826.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,826.70
|
|
|
HC ED MOLD SKT EXP INTERF FLEX HI
|
Facility
|
IP
|
$4,502.00
|
|
|
Service Code
|
CPT L6055
|
| Hospital Charge Code |
905356055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$900.40 |
| Max. Negotiated Rate |
$4,051.80 |
| Rate for Payer: Blue Shield of California EPN |
$2,404.07
|
| Rate for Payer: Cash Price |
$2,025.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,601.60
|
| Rate for Payer: Cigna of CA HMO |
$3,151.40
|
| Rate for Payer: Cigna of CA PPO |
$3,151.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$900.40
|
| 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: United Healthcare All Other Commercial |
$1,699.96
|
| Rate for Payer: United Healthcare All Other HMO |
$1,660.34
|
| Rate for Payer: United Healthcare HMO Rider |
$1,624.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,485.66
|
|
|
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: Blue Shield of California EPN |
$1,132.08
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,696.00
|
| Rate for Payer: Cigna of CA HMO |
$1,484.00
|
| Rate for Payer: Cigna of CA PPO |
$1,484.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$424.00
|
| 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: United Healthcare All Other Commercial |
$800.51
|
| Rate for Payer: United Healthcare All Other HMO |
$781.86
|
| Rate for Payer: United Healthcare HMO Rider |
$764.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$699.60
|
|
|
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 |
$742.00 |
| Max. Negotiated Rate |
$1,908.00 |
| 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 |
$1,166.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,026.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,252.50
|
| Rate for Payer: Blue Distinction Transplant |
$1,272.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,590.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,153.28
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,696.00
|
| Rate for Payer: Cigna of CA HMO |
$1,484.00
|
| Rate for Payer: Cigna of CA PPO |
$1,484.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Dignity Health Media |
$1,802.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,802.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,590.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$742.00
|
| 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: LLUH Dept of Risk Management WC |
$869.20
|
| 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 |
$1,060.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,060.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,060.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,060.00
|
| 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 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: Blue Shield of California EPN |
$3,556.97
|
| Rate for Payer: Cash Price |
$2,997.45
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$1,332.20
|
| 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: United Healthcare All Other Commercial |
$2,515.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,456.58
|
| Rate for Payer: United Healthcare HMO Rider |
$2,403.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,198.13
|
|
|
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 |
$2,169.67 |
| Max. Negotiated Rate |
$5,994.90 |
| 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 |
$3,663.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,225.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,935.32
|
| Rate for Payer: Blue Distinction Transplant |
$3,996.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,995.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,623.58
|
| Rate for Payer: Cash Price |
$2,997.45
|
| Rate for Payer: Cash Price |
$2,997.45
|
| 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 Media |
$5,661.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,661.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$4,995.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,331.35
|
| 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: LLUH Dept of Risk Management WC |
$2,731.01
|
| 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 |
$3,330.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,330.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,330.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,330.50
|
| 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
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804115
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Central Health Plan Commercial |
$249.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Networks By Design Commercial |
$202.80
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
|
|
HC ED OT TASK GROUP
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804115
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.33
|
| Rate for Payer: Blue Distinction Transplant |
$187.20
|
| Rate for Payer: Blue Shield of California Commercial |
$196.25
|
| Rate for Payer: Blue Shield of California EPN |
$152.57
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Central Health Plan Commercial |
$249.60
|
| Rate for Payer: Cigna of CA HMO |
$199.68
|
| Rate for Payer: Cigna of CA PPO |
$230.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$234.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Networks By Design Commercial |
$202.80
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.00
|
| Rate for Payer: United Healthcare All Other HMO |
$156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC EDUCATION ED MENTAL HEALTH
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$162.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.92
|
| Rate for Payer: Blue Distinction Transplant |
$201.00
|
| Rate for Payer: Blue Shield of California Commercial |
$210.72
|
| Rate for Payer: Blue Shield of California EPN |
$163.82
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: Cigna of CA HMO |
$214.40
|
| Rate for Payer: Cigna of CA PPO |
$247.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$251.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$223.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC EDUCATION ED MENTAL HEALTH
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.00
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$223.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
|
|
HC EDUCATION MENTAL HEALTH
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804065
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
|
