|
HC IOC TOUCH-PREP ADDL SITE PG
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
903800222
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$94.39 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.82
|
| Rate for Payer: Blue Shield of California Commercial |
$30.96
|
| Rate for Payer: Blue Shield of California EPN |
$20.25
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$85.45
|
| Rate for Payer: InnovAge PACE Commercial |
$25.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.70
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Riverside University Health System MISP |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.70
|
| Rate for Payer: United Healthcare All Other HMO |
$15.70
|
| Rate for Payer: United Healthcare HMO Rider |
$15.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.35
|
| Rate for Payer: Vantage Medical Group Senior |
$43.35
|
|
|
HC IOC TOUCH-PREP INITIAL PG
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800221
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: EPIC Health Plan Senior |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$584.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
|
|
HC IOC TOUCH-PREP INITIAL PG
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800221
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,037.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$573.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.23
|
| Rate for Payer: Blue Shield of California Commercial |
$573.01
|
| Rate for Payer: Blue Shield of California EPN |
$374.77
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: Cigna of CA HMO |
$604.16
|
| Rate for Payer: Cigna of CA PPO |
$698.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$136.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: InnovAge PACE Commercial |
$1,556.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,390.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Prime Health Services Medicare |
$1,100.23
|
| Rate for Payer: Riverside University Health System MISP |
$1,141.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC IONTOHORESIS 15MIN OT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
905104123
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.79
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC IONTOHORESIS 15MIN OT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
905104123
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC IONTOPHORESIS 15 MIN MCAL
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900400027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.79
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC IONTOPHORESIS 15 MIN MCAL
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900400027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC IONTOPHORESIS 15 MIN MCARE COMM
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900407033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.79
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC IONTOPHORESIS 15 MIN MCARE COMM
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900407033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC IONTOPHORESIS 15 MIN PT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
905103123
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC IONTOPHORESIS 15 MIN PT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
905103123
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.79
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC IONTOPHORESIS 15 MIN PT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900417033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC IONTOPHORESIS 15 MIN PT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900417033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.79
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC IOP COGNITIVE THERAPY
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804061
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.17
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
|
|
HC IOP COGNITIVE THERAPY
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804061
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.14
|
| 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 |
$208.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.54
|
| Rate for Payer: Blue Shield of California Commercial |
$262.73
|
| Rate for Payer: Blue Shield of California EPN |
$171.57
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: Cigna of CA HMO |
$275.20
|
| Rate for Payer: Cigna of CA PPO |
$318.20
|
| 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 |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| 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 |
$258.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.00
|
| Rate for Payer: United Healthcare All Other HMO |
$215.00
|
| Rate for Payer: United Healthcare HMO Rider |
$215.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.00
|
| 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 IOP CONNECTION GROUP
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804376
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC IOP CONNECTION GROUP
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804376
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$237.45
|
| 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 |
$189.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.63
|
| Rate for Payer: Blue Shield of California Commercial |
$238.90
|
| Rate for Payer: Blue Shield of California EPN |
$156.01
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| 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 |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| 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 |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC IOP COPING SKILLS
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804060
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.17
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
|
|
HC IOP COPING SKILLS
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804060
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.14
|
| 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 |
$208.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.54
|
| Rate for Payer: Blue Shield of California Commercial |
$262.73
|
| Rate for Payer: Blue Shield of California EPN |
$171.57
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: Cigna of CA HMO |
$275.20
|
| Rate for Payer: Cigna of CA PPO |
$318.20
|
| 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 |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| 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 |
$258.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.00
|
| Rate for Payer: United Healthcare All Other HMO |
$215.00
|
| Rate for Payer: United Healthcare HMO Rider |
$215.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.00
|
| 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 IOP ED COGNITIVE THERAPY
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804141
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Adventist Health Commercial |
$88.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$269.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$214.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.17
|
| Rate for Payer: Blue Shield of California Commercial |
$270.67
|
| Rate for Payer: Blue Shield of California EPN |
$176.76
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Central Health Plan Commercial |
$354.40
|
| Rate for Payer: Cigna of CA HMO |
$283.52
|
| Rate for Payer: Cigna of CA PPO |
$327.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$398.70
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$295.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$332.25
|
| Rate for Payer: Networks By Design Commercial |
$287.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$376.55
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.50
|
| Rate for Payer: United Healthcare All Other HMO |
$221.50
|
| Rate for Payer: United Healthcare HMO Rider |
$221.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$221.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC IOP ED COGNITIVE THERAPY
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804141
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$88.60 |
| Max. Negotiated Rate |
$398.70 |
| Rate for Payer: Adventist Health Commercial |
$88.60
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Central Health Plan Commercial |
$354.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.20
|
| Rate for Payer: EPIC Health Plan Senior |
$177.20
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$398.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$295.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$274.22
|
| Rate for Payer: Multiplan Commercial |
$332.25
|
| Rate for Payer: Networks By Design Commercial |
$287.95
|
| Rate for Payer: Prime Health Services Commercial |
$376.55
|
|
|
HC IOP ED COPING SKILLS
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804140
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Adventist Health Commercial |
$88.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$269.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$214.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.17
|
| Rate for Payer: Blue Shield of California Commercial |
$270.67
|
| Rate for Payer: Blue Shield of California EPN |
$176.76
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Central Health Plan Commercial |
$354.40
|
| Rate for Payer: Cigna of CA HMO |
$283.52
|
| Rate for Payer: Cigna of CA PPO |
$327.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$398.70
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$295.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$332.25
|
| Rate for Payer: Networks By Design Commercial |
$287.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$376.55
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.50
|
| Rate for Payer: United Healthcare All Other HMO |
$221.50
|
| Rate for Payer: United Healthcare HMO Rider |
$221.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$221.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC IOP ED COPING SKILLS
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804140
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$88.60 |
| Max. Negotiated Rate |
$398.70 |
| Rate for Payer: Adventist Health Commercial |
$88.60
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Central Health Plan Commercial |
$354.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.20
|
| Rate for Payer: EPIC Health Plan Senior |
$177.20
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$398.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$295.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$274.22
|
| Rate for Payer: Multiplan Commercial |
$332.25
|
| Rate for Payer: Networks By Design Commercial |
$287.95
|
| Rate for Payer: Prime Health Services Commercial |
$376.55
|
|
|
HC IOP ED FAMILY THERAPY W PATIENT
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
907804156
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$497.70 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Cash Price |
$304.15
|
| Rate for Payer: Central Health Plan Commercial |
$442.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$497.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.31
|
| Rate for Payer: Multiplan Commercial |
$414.75
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
|
|
HC IOP ED FAMILY THERAPY W PATIENT
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
907804156
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$87.72 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$204.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$335.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$267.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$324.78
|
| Rate for Payer: Blue Shield of California Commercial |
$337.88
|
| Rate for Payer: Blue Shield of California EPN |
$220.65
|
| Rate for Payer: Cash Price |
$304.15
|
| Rate for Payer: Cash Price |
$304.15
|
| Rate for Payer: Cash Price |
$304.15
|
| Rate for Payer: Central Health Plan Commercial |
$442.40
|
| Rate for Payer: Cigna of CA HMO |
$353.92
|
| Rate for Payer: Cigna of CA PPO |
$409.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Senior |
$204.15
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$497.70
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.15
|
| Rate for Payer: InnovAge PACE Commercial |
$306.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.56
|
| Rate for Payer: Multiplan Commercial |
$414.75
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$204.15
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
| Rate for Payer: Prime Health Services Medicare |
$216.40
|
| Rate for Payer: Riverside University Health System MISP |
$224.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.50
|
| Rate for Payer: United Healthcare All Other HMO |
$276.50
|
| Rate for Payer: United Healthcare HMO Rider |
$276.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$204.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Vantage Medical Group Senior |
$204.15
|
|
