|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$521.53 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$521.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.96
|
| Rate for Payer: Blue Shield of California Commercial |
$306.22
|
| Rate for Payer: Blue Shield of California EPN |
$192.72
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$410.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Riverside University Health System MISP |
$193.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.50
|
| Rate for Payer: United Healthcare All Other HMO |
$241.50
|
| Rate for Payer: United Healthcare HMO Rider |
$241.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.97
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$521.53 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$521.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.96
|
| Rate for Payer: Blue Shield of California Commercial |
$306.22
|
| Rate for Payer: Blue Shield of California EPN |
$192.72
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$410.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Riverside University Health System MISP |
$193.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC PSYCH 45 MIN W PT W EVAL
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
900100704
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$736.28 |
| Rate for Payer: Adventist Health Commercial |
$120.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$736.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$512.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$452.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$291.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.77
|
| Rate for Payer: Blue Shield of California Commercial |
$382.30
|
| Rate for Payer: Blue Shield of California EPN |
$240.60
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Central Health Plan Commercial |
$482.40
|
| Rate for Payer: Cigna of CA HMO |
$385.92
|
| Rate for Payer: Cigna of CA PPO |
$446.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$512.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$512.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$512.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$422.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$241.20
|
| Rate for Payer: Galaxy Health WC |
$512.55
|
| Rate for Payer: Global Benefits Group Commercial |
$361.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$542.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$382.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$355.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$422.10
|
| Rate for Payer: Multiplan Commercial |
$452.25
|
| Rate for Payer: Networks By Design Commercial |
$391.95
|
| Rate for Payer: Prime Health Services Commercial |
$512.55
|
| Rate for Payer: Riverside University Health System MISP |
$241.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$361.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$361.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$512.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$512.55
|
| Rate for Payer: Vantage Medical Group Senior |
$512.55
|
|
|
HC PSYCH 45 MIN W PT W EVAL
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
900100704
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$542.70 |
| Rate for Payer: Adventist Health Commercial |
$120.60
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Central Health Plan Commercial |
$482.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$422.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$241.20
|
| Rate for Payer: Galaxy Health WC |
$512.55
|
| Rate for Payer: Global Benefits Group Commercial |
$361.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$542.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$382.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$355.77
|
| Rate for Payer: Multiplan Commercial |
$452.25
|
| Rate for Payer: Networks By Design Commercial |
$391.95
|
| Rate for Payer: Prime Health Services Commercial |
$512.55
|
|
|
HC PSYCH 60 MIN W PT W EVAL
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
900100705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$846.73 |
| Rate for Payer: Adventist Health Commercial |
$126.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$846.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$537.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$347.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$474.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$306.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$367.63
|
| Rate for Payer: Blue Shield of California Commercial |
$400.69
|
| Rate for Payer: Blue Shield of California EPN |
$252.17
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Central Health Plan Commercial |
$505.60
|
| Rate for Payer: Cigna of CA HMO |
$404.48
|
| Rate for Payer: Cigna of CA PPO |
$467.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$537.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$537.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$537.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$442.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.80
|
| Rate for Payer: EPIC Health Plan Senior |
$252.80
|
| Rate for Payer: Galaxy Health WC |
$537.20
|
| Rate for Payer: Global Benefits Group Commercial |
$379.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$568.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$179.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$372.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$442.40
|
| Rate for Payer: Multiplan Commercial |
$474.00
|
| Rate for Payer: Networks By Design Commercial |
$410.80
|
| Rate for Payer: Prime Health Services Commercial |
$537.20
|
| Rate for Payer: Riverside University Health System MISP |
$252.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$379.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$379.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$537.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$537.20
|
| Rate for Payer: Vantage Medical Group Senior |
$537.20
|
|
|
HC PSYCH 60 MIN W PT W EVAL
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
900100705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$568.80 |
| Rate for Payer: Adventist Health Commercial |
$126.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Central Health Plan Commercial |
$505.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$442.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.80
|
| Rate for Payer: EPIC Health Plan Senior |
$252.80
|
| Rate for Payer: Galaxy Health WC |
$537.20
|
| Rate for Payer: Global Benefits Group Commercial |
$379.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$568.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$372.88
|
| Rate for Payer: Multiplan Commercial |
$474.00
|
| Rate for Payer: Networks By Design Commercial |
$410.80
|
| Rate for Payer: Prime Health Services Commercial |
$537.20
|
|
|
HC PSYCH CRISIS EA ADD 30 MIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
900100707
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC PSYCH CRISIS EA ADD 30 MIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
900100707
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.78
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC PSYCH CRISIS EA ADD 30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
900100707
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$506.20 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$506.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.77
|
| Rate for Payer: Blue Shield of California Commercial |
$153.43
|
| Rate for Payer: Blue Shield of California EPN |
$96.56
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$205.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$169.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Riverside University Health System MISP |
$96.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$121.00
|
| Rate for Payer: United Healthcare HMO Rider |
$121.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC PSYCH CRISIS EA ADD 30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
900100707
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$506.20 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$506.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.77
|
| Rate for Payer: Blue Shield of California Commercial |
$153.43
|
| Rate for Payer: Blue Shield of California EPN |
$96.56
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$205.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$169.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Riverside University Health System MISP |
$96.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC PSYCH CRISIS FIRST 60 MIN
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
900100706
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.40 |
| Max. Negotiated Rate |
$492.30 |
| Rate for Payer: Adventist Health Commercial |
$109.40
|
| Rate for Payer: Cash Price |
$246.15
|
| Rate for Payer: Central Health Plan Commercial |
$437.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$382.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.80
|
| Rate for Payer: EPIC Health Plan Senior |
$218.80
|
| Rate for Payer: Galaxy Health WC |
$464.95
|
| Rate for Payer: Global Benefits Group Commercial |
$328.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$492.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$347.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$322.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.40
|
| Rate for Payer: Multiplan Commercial |
$410.25
|
| Rate for Payer: Networks By Design Commercial |
$355.55
|
| Rate for Payer: Prime Health Services Commercial |
$464.95
|
|
|
HC PSYCH CRISIS FIRST 60 MIN
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
900100706
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.38 |
| Max. Negotiated Rate |
$1,012.39 |
| Rate for Payer: Adventist Health Commercial |
$109.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,012.39
|
| 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 |
$264.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$318.19
|
| Rate for Payer: Blue Shield of California Commercial |
$346.80
|
| Rate for Payer: Blue Shield of California EPN |
$218.25
|
| Rate for Payer: Cash Price |
$246.15
|
| Rate for Payer: Cash Price |
$246.15
|
| Rate for Payer: Central Health Plan Commercial |
$437.60
|
| Rate for Payer: Cigna of CA HMO |
$350.08
|
| Rate for Payer: Cigna of CA PPO |
$404.78
|
| 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 |
$382.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$464.95
|
| Rate for Payer: Global Benefits Group Commercial |
$328.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$492.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$347.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$410.25
|
| Rate for Payer: Networks By Design Commercial |
$355.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$464.95
|
| 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 |
$328.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$328.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$273.50
|
| Rate for Payer: United Healthcare All Other HMO |
$273.50
|
| Rate for Payer: United Healthcare HMO Rider |
$273.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$273.50
|
| 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 PSYCH CRISIS FIRST 60 MIN
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
900100706
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$109.40 |
| Max. Negotiated Rate |
$492.30 |
| Rate for Payer: Adventist Health Commercial |
$109.40
|
| Rate for Payer: Cash Price |
$246.15
|
| Rate for Payer: Central Health Plan Commercial |
$437.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$382.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.80
|
| Rate for Payer: EPIC Health Plan Senior |
$218.80
|
| Rate for Payer: Galaxy Health WC |
$464.95
|
| Rate for Payer: Global Benefits Group Commercial |
$328.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$492.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$347.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$322.73
|
| Rate for Payer: Multiplan Commercial |
$410.25
|
| Rate for Payer: Networks By Design Commercial |
$355.55
|
| Rate for Payer: Prime Health Services Commercial |
$464.95
|
|
|
HC PSYCH CRISIS FIRST 60 MIN
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
900100706
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$65.38 |
| Max. Negotiated Rate |
$1,012.39 |
| Rate for Payer: Adventist Health Commercial |
$109.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,012.39
|
| 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 |
$264.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$318.19
|
| Rate for Payer: Blue Shield of California Commercial |
$346.80
|
| Rate for Payer: Blue Shield of California EPN |
$218.25
|
| Rate for Payer: Cash Price |
$246.15
|
| Rate for Payer: Cash Price |
$246.15
|
| Rate for Payer: Central Health Plan Commercial |
$437.60
|
| Rate for Payer: Cigna of CA HMO |
$350.08
|
| Rate for Payer: Cigna of CA PPO |
$404.78
|
| 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 |
$382.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$464.95
|
| Rate for Payer: Global Benefits Group Commercial |
$328.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$492.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$347.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.22
|
| 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 |
$410.25
|
| Rate for Payer: Networks By Design Commercial |
$355.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$464.95
|
| 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 |
$328.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$328.20
|
| 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 PSYCH DIAGNOSTIC EVALUATION
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
950900000
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$1,570.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,012.39
|
| 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 |
$72.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.25
|
| Rate for Payer: Blue Shield of California Commercial |
$95.10
|
| Rate for Payer: Blue Shield of California EPN |
$59.85
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| 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 |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$220.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$243.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| 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 |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,496.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,129.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 PSYCH DIAGNOSTIC EVALUATION
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
950900000
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC PSYCHIATRIC DIAGNOSTIC EVAL
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
900100712
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$1,012.39 |
| Rate for Payer: Adventist Health Commercial |
$120.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,012.39
|
| 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 |
$291.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.77
|
| Rate for Payer: Blue Shield of California Commercial |
$382.30
|
| Rate for Payer: Blue Shield of California EPN |
$240.60
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Central Health Plan Commercial |
$482.40
|
| Rate for Payer: Cigna of CA HMO |
$385.92
|
| Rate for Payer: Cigna of CA PPO |
$446.22
|
| 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 |
$422.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$512.55
|
| Rate for Payer: Global Benefits Group Commercial |
$361.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$542.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$220.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$382.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$243.35
|
| 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 |
$452.25
|
| Rate for Payer: Networks By Design Commercial |
$391.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$512.55
|
| 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 |
$361.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$361.80
|
| 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 PSYCHIATRIC DIAGNOSTIC EVAL
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
900100712
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$542.70 |
| Rate for Payer: Adventist Health Commercial |
$120.60
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Central Health Plan Commercial |
$482.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$422.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$241.20
|
| Rate for Payer: Galaxy Health WC |
$512.55
|
| Rate for Payer: Global Benefits Group Commercial |
$361.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$542.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$382.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$355.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.60
|
| Rate for Payer: Multiplan Commercial |
$452.25
|
| Rate for Payer: Networks By Design Commercial |
$391.95
|
| Rate for Payer: Prime Health Services Commercial |
$512.55
|
|
|
HC PSYCHIATRIC DIAGNOSTIC EVAL
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
900100712
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$1,012.39 |
| Rate for Payer: Adventist Health Commercial |
$120.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,012.39
|
| 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 |
$291.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.77
|
| Rate for Payer: Blue Shield of California Commercial |
$382.30
|
| Rate for Payer: Blue Shield of California EPN |
$240.60
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Central Health Plan Commercial |
$482.40
|
| Rate for Payer: Cigna of CA HMO |
$385.92
|
| Rate for Payer: Cigna of CA PPO |
$446.22
|
| 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 |
$422.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$512.55
|
| Rate for Payer: Global Benefits Group Commercial |
$361.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$542.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$220.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$382.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$243.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$452.25
|
| Rate for Payer: Networks By Design Commercial |
$391.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$512.55
|
| 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 |
$361.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$361.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$301.50
|
| Rate for Payer: United Healthcare All Other HMO |
$301.50
|
| Rate for Payer: United Healthcare HMO Rider |
$301.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$301.50
|
| 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 PSYCHIATRIC DIAGNOSTIC EVAL
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
900100712
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$542.70 |
| Rate for Payer: Adventist Health Commercial |
$120.60
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Central Health Plan Commercial |
$482.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$422.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$241.20
|
| Rate for Payer: Galaxy Health WC |
$512.55
|
| Rate for Payer: Global Benefits Group Commercial |
$361.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$542.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$382.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$355.77
|
| Rate for Payer: Multiplan Commercial |
$452.25
|
| Rate for Payer: Networks By Design Commercial |
$391.95
|
| Rate for Payer: Prime Health Services Commercial |
$512.55
|
|
|
HC PSYCHIATRIC SERVICE OR PROC
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 90899
|
| Hospital Charge Code |
900100713
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC PSYCHIATRIC SERVICE OR PROC
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 90899
|
| Hospital Charge Code |
900100713
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$48.19 |
| Max. Negotiated Rate |
$1,570.00 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.96
|
| Rate for Payer: Blue Shield of California Commercial |
$306.22
|
| Rate for Payer: Blue Shield of California EPN |
$192.72
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.51
|
| Rate for Payer: EPIC Health Plan Senior |
$53.01
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.57
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.19
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Prime Health Services Medicare |
$51.08
|
| Rate for Payer: Riverside University Health System MISP |
$53.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,496.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,129.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Vantage Medical Group Senior |
$48.19
|
|
|
HC PSYCHOTHERAPY 30 MIN W PT
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
900100700
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.10
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
|
