|
HC PHP YOUTH IOP OCCUPATIONAL THERAPY
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804355
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.56
|
| Rate for Payer: Blue Shield of California Commercial |
$237.12
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.59
|
| Rate for Payer: EPIC Health Plan Senior |
$143.73
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.66
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$138.50
|
| Rate for Payer: Riverside University Health System MISP |
$143.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC PHP YOUTH IOP OCCUPATIONAL THERAPY
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804355
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.66
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC PHP YOUTH IOP PROCESS
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804342
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.56
|
| Rate for Payer: Blue Shield of California Commercial |
$237.12
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.59
|
| Rate for Payer: EPIC Health Plan Senior |
$143.73
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.66
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$138.50
|
| Rate for Payer: Riverside University Health System MISP |
$143.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC PHP YOUTH IOP PROCESS
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804342
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.66
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC PHP YOUTH IOP STRESS MANAGEMENT
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804348
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$183.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.58
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
|
|
HC PHP YOUTH IOP STRESS MANAGEMENT
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804348
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$674.93 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$674.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.41
|
| Rate for Payer: Blue Shield of California Commercial |
$166.11
|
| Rate for Payer: Blue Shield of California EPN |
$104.54
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: Cigna of CA HMO |
$167.68
|
| Rate for Payer: Cigna of CA PPO |
$193.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$183.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
| Rate for Payer: Prime Health Services Medicare |
$241.99
|
| Rate for Payer: Riverside University Health System MISP |
$251.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
HC PHP YOUTH MENTAL HEALTH ED
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804306
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.56
|
| Rate for Payer: Blue Shield of California Commercial |
$237.12
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.59
|
| Rate for Payer: EPIC Health Plan Senior |
$143.73
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.66
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$138.50
|
| Rate for Payer: Riverside University Health System MISP |
$143.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC PHP YOUTH MENTAL HEALTH ED
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804306
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.66
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC PHP YOUTH MULTI FAMILY
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804319
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.66
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC PHP YOUTH MULTI FAMILY
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804319
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.56
|
| Rate for Payer: Blue Shield of California Commercial |
$237.12
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.59
|
| Rate for Payer: EPIC Health Plan Senior |
$143.73
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.66
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$138.50
|
| Rate for Payer: Riverside University Health System MISP |
$143.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC PHP YOUTH OCCUPATIONAL THERAPY
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804315
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.56
|
| Rate for Payer: Blue Shield of California Commercial |
$237.12
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.59
|
| Rate for Payer: EPIC Health Plan Senior |
$143.73
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.66
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$138.50
|
| Rate for Payer: Riverside University Health System MISP |
$143.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC PHP YOUTH OCCUPATIONAL THERAPY
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804315
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.66
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC PHP YOUTH PROCESS
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804302
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.56
|
| Rate for Payer: Blue Shield of California Commercial |
$237.12
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.59
|
| Rate for Payer: EPIC Health Plan Senior |
$143.73
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.66
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$138.50
|
| Rate for Payer: Riverside University Health System MISP |
$143.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC PHP YOUTH PROCESS
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804302
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.66
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC PHP YOUTH STRESS MANAGEMENT
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804308
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$361.80 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Central Health Plan Commercial |
$321.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$281.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Senior |
$160.80
|
| Rate for Payer: Galaxy Health WC |
$341.70
|
| Rate for Payer: Global Benefits Group Commercial |
$241.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$361.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$237.18
|
| Rate for Payer: Multiplan Commercial |
$301.50
|
| Rate for Payer: Networks By Design Commercial |
$261.30
|
| Rate for Payer: Prime Health Services Commercial |
$341.70
|
|
|
HC PHP YOUTH STRESS MANAGEMENT
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804308
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$674.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$194.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.84
|
| Rate for Payer: Blue Shield of California Commercial |
$254.87
|
| Rate for Payer: Blue Shield of California EPN |
$160.40
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Central Health Plan Commercial |
$321.60
|
| Rate for Payer: Cigna of CA HMO |
$257.28
|
| Rate for Payer: Cigna of CA PPO |
$297.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$281.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$341.70
|
| Rate for Payer: Global Benefits Group Commercial |
$241.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$361.80
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$301.50
|
| Rate for Payer: Networks By Design Commercial |
$261.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$341.70
|
| Rate for Payer: Prime Health Services Medicare |
$241.99
|
| Rate for Payer: Riverside University Health System MISP |
$251.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
HC PHRNC NRV STIM INSRT GEN, LEAD
|
Facility
|
IP
|
$143,776.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906810424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$28,755.20 |
| Max. Negotiated Rate |
$129,398.40 |
| Rate for Payer: Adventist Health Commercial |
$28,755.20
|
| Rate for Payer: Cash Price |
$64,699.20
|
| Rate for Payer: Central Health Plan Commercial |
$115,020.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100,643.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,510.40
|
| Rate for Payer: EPIC Health Plan Senior |
$57,510.40
|
| Rate for Payer: Galaxy Health WC |
$122,209.60
|
| Rate for Payer: Global Benefits Group Commercial |
$86,265.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$129,398.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91,297.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84,827.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28,755.20
|
| Rate for Payer: Multiplan Commercial |
$107,832.00
|
| Rate for Payer: Networks By Design Commercial |
$93,454.40
|
| Rate for Payer: Prime Health Services Commercial |
$122,209.60
|
|
|
HC PHRNC NRV STIM INSRT GEN, LEAD
|
Facility
|
OP
|
$143,776.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906810424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,736.00 |
| Max. Negotiated Rate |
$129,398.40 |
| Rate for Payer: Adventist Health Commercial |
$28,755.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122,209.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79,076.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$107,832.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$64,699.20
|
| Rate for Payer: Cash Price |
$64,699.20
|
| Rate for Payer: Central Health Plan Commercial |
$115,020.80
|
| Rate for Payer: Cigna of CA HMO |
$92,016.64
|
| Rate for Payer: Cigna of CA PPO |
$106,394.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122,209.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$122,209.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122,209.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100,643.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,510.40
|
| Rate for Payer: EPIC Health Plan Senior |
$57,510.40
|
| Rate for Payer: Galaxy Health WC |
$122,209.60
|
| Rate for Payer: Global Benefits Group Commercial |
$86,265.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$129,398.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91,297.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52,190.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84,827.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28,755.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100,643.20
|
| Rate for Payer: Multiplan Commercial |
$107,832.00
|
| Rate for Payer: Networks By Design Commercial |
$93,454.40
|
| Rate for Payer: Prime Health Services Commercial |
$122,209.60
|
| Rate for Payer: Riverside University Health System MISP |
$57,510.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86,265.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$71,888.00
|
| Rate for Payer: United Healthcare All Other HMO |
$97,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,134.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122,209.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122,209.60
|
| Rate for Payer: Vantage Medical Group Senior |
$122,209.60
|
|
|
HC PHRNC NRV STIM INSRT TRNSVNS LEAD
|
Facility
|
IP
|
$30,550.00
|
|
|
Service Code
|
CPT 0425T
|
| Hospital Charge Code |
906810425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,110.00 |
| Max. Negotiated Rate |
$27,495.00 |
| Rate for Payer: Adventist Health Commercial |
$6,110.00
|
| Rate for Payer: Cash Price |
$13,747.50
|
| Rate for Payer: Central Health Plan Commercial |
$24,440.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,385.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,220.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,220.00
|
| Rate for Payer: Galaxy Health WC |
$25,967.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,330.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,495.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,399.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,024.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,110.00
|
| Rate for Payer: Multiplan Commercial |
$22,912.50
|
| Rate for Payer: Networks By Design Commercial |
$19,857.50
|
| Rate for Payer: Prime Health Services Commercial |
$25,967.50
|
|
|
HC PHRNC NRV STIM INSRT TRNSVNS LEAD
|
Facility
|
OP
|
$30,550.00
|
|
|
Service Code
|
CPT 0425T
|
| Hospital Charge Code |
906810425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,974.00 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$6,110.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,967.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,802.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,912.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$13,747.50
|
| Rate for Payer: Cash Price |
$13,747.50
|
| Rate for Payer: Central Health Plan Commercial |
$24,440.00
|
| Rate for Payer: Cigna of CA HMO |
$19,552.00
|
| Rate for Payer: Cigna of CA PPO |
$22,607.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,967.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,967.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,967.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,385.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,220.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,220.00
|
| Rate for Payer: Galaxy Health WC |
$25,967.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,330.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,495.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,399.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,089.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,024.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,110.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,385.00
|
| Rate for Payer: Multiplan Commercial |
$22,912.50
|
| Rate for Payer: Networks By Design Commercial |
$19,857.50
|
| Rate for Payer: Prime Health Services Commercial |
$25,967.50
|
| Rate for Payer: Riverside University Health System MISP |
$12,220.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,330.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,275.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,967.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,967.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,967.50
|
|
|
HC PHRNC NRV STIM REMOVAL, REPL GEN
|
Facility
|
IP
|
$143,776.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906810431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$28,755.20 |
| Max. Negotiated Rate |
$129,398.40 |
| Rate for Payer: Adventist Health Commercial |
$28,755.20
|
| Rate for Payer: Cash Price |
$64,699.20
|
| Rate for Payer: Central Health Plan Commercial |
$115,020.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100,643.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,510.40
|
| Rate for Payer: EPIC Health Plan Senior |
$57,510.40
|
| Rate for Payer: Galaxy Health WC |
$122,209.60
|
| Rate for Payer: Global Benefits Group Commercial |
$86,265.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$129,398.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91,297.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84,827.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28,755.20
|
| Rate for Payer: Multiplan Commercial |
$107,832.00
|
| Rate for Payer: Networks By Design Commercial |
$93,454.40
|
| Rate for Payer: Prime Health Services Commercial |
$122,209.60
|
|
|
HC PHRNC NRV STIM REMOVAL, REPL GEN
|
Facility
|
OP
|
$143,776.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906810431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,736.00 |
| Max. Negotiated Rate |
$129,398.40 |
| Rate for Payer: Adventist Health Commercial |
$28,755.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122,209.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79,076.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$107,832.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$64,699.20
|
| Rate for Payer: Cash Price |
$64,699.20
|
| Rate for Payer: Central Health Plan Commercial |
$115,020.80
|
| Rate for Payer: Cigna of CA HMO |
$92,016.64
|
| Rate for Payer: Cigna of CA PPO |
$106,394.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122,209.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$122,209.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122,209.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100,643.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,510.40
|
| Rate for Payer: EPIC Health Plan Senior |
$57,510.40
|
| Rate for Payer: Galaxy Health WC |
$122,209.60
|
| Rate for Payer: Global Benefits Group Commercial |
$86,265.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$129,398.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91,297.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52,190.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84,827.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28,755.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100,643.20
|
| Rate for Payer: Multiplan Commercial |
$107,832.00
|
| Rate for Payer: Networks By Design Commercial |
$93,454.40
|
| Rate for Payer: Prime Health Services Commercial |
$122,209.60
|
| Rate for Payer: Riverside University Health System MISP |
$57,510.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86,265.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$71,888.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122,209.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122,209.60
|
| Rate for Payer: Vantage Medical Group Senior |
$122,209.60
|
|
|
HC PHRNC NRV STIM REMOVAL , REPL TRNSVNS LEAD
|
Facility
|
OP
|
$95,194.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906810426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,974.00 |
| Max. Negotiated Rate |
$85,674.60 |
| Rate for Payer: Adventist Health Commercial |
$19,038.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80,914.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52,356.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71,395.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$42,837.30
|
| Rate for Payer: Cash Price |
$42,837.30
|
| Rate for Payer: Central Health Plan Commercial |
$76,155.20
|
| Rate for Payer: Cigna of CA HMO |
$60,924.16
|
| Rate for Payer: Cigna of CA PPO |
$70,443.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80,914.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$80,914.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80,914.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66,635.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,077.60
|
| Rate for Payer: EPIC Health Plan Senior |
$38,077.60
|
| Rate for Payer: Galaxy Health WC |
$80,914.90
|
| Rate for Payer: Global Benefits Group Commercial |
$57,116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$85,674.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60,448.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34,555.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56,164.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,038.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$66,635.80
|
| Rate for Payer: Multiplan Commercial |
$71,395.50
|
| Rate for Payer: Networks By Design Commercial |
$61,876.10
|
| Rate for Payer: Prime Health Services Commercial |
$80,914.90
|
| Rate for Payer: Riverside University Health System MISP |
$38,077.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57,116.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$47,597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$80,914.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80,914.90
|
| Rate for Payer: Vantage Medical Group Senior |
$80,914.90
|
|
|
HC PHRNC NRV STIM REMOVAL , REPL TRNSVNS LEAD
|
Facility
|
IP
|
$95,194.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906810426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19,038.80 |
| Max. Negotiated Rate |
$85,674.60 |
| Rate for Payer: Adventist Health Commercial |
$19,038.80
|
| Rate for Payer: Cash Price |
$42,837.30
|
| Rate for Payer: Central Health Plan Commercial |
$76,155.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66,635.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,077.60
|
| Rate for Payer: EPIC Health Plan Senior |
$38,077.60
|
| Rate for Payer: Galaxy Health WC |
$80,914.90
|
| Rate for Payer: Global Benefits Group Commercial |
$57,116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$85,674.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60,448.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56,164.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,038.80
|
| Rate for Payer: Multiplan Commercial |
$71,395.50
|
| Rate for Payer: Networks By Design Commercial |
$61,876.10
|
| Rate for Payer: Prime Health Services Commercial |
$80,914.90
|
|
|
HC PHRNC NRV STIM REMOVAL TRNSVNS
|
Facility
|
OP
|
$15,546.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906810430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,550.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,659.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: Cigna of CA HMO |
$9,949.44
|
| Rate for Payer: Cigna of CA PPO |
$11,504.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,214.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,214.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,882.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,871.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,643.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,172.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,882.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
| Rate for Payer: Riverside University Health System MISP |
$6,218.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,327.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,773.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13,214.10
|
|
