|
HC PSYCHOTHERAPY 30 MIN W PT
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
900100700
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$464.17 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$464.17
|
| 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 |
$140.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.69
|
| Rate for Payer: Blue Shield of California Commercial |
$183.86
|
| Rate for Payer: Blue Shield of California EPN |
$115.71
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$185.60
|
| Rate for Payer: Cigna of CA PPO |
$214.60
|
| 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 |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| 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 |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.00
|
| Rate for Payer: United Healthcare All Other HMO |
$145.00
|
| Rate for Payer: United Healthcare HMO Rider |
$145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.00
|
| 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 PSYCHOTHERAPY 30 MIN W PT
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
900100700
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$464.17 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$464.17
|
| 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 |
$140.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.69
|
| Rate for Payer: Blue Shield of California Commercial |
$183.86
|
| Rate for Payer: Blue Shield of California EPN |
$115.71
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$185.60
|
| Rate for Payer: Cigna of CA PPO |
$214.60
|
| 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 |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.45
|
| 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 |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| 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 |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| 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 PSYCHOTHERAPY 30 MIN W PT
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
900100700
|
|
Hospital Revenue Code
|
510
|
| 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: LLUH Dept of Risk Management WC |
$58.00
|
| 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
|
|
|
HC PSYCHOTHERAPY 45 MIN W PT
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
900100701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$674.93 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| 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 |
$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 |
$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 |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$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 |
$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 |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| 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 |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| 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 |
$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: 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 PSYCHOTHERAPY 45 MIN W PT
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
900100701
|
|
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 PSYCHOTHERAPY 45 MIN W PT
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
900100701
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$674.93 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| 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 |
$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 |
$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 |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$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 |
$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 |
$306.70
|
| 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 |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| 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 |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| 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 PSYCHOTHERAPY 45 MIN W PT
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
900100701
|
|
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 PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
900100702
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$924.10 |
| 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 |
$924.10
|
| 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 |
$168.59
|
| 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 |
$186.24
|
| 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 PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
900100702
|
|
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 PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
900100702
|
|
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 PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
900100702
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$924.10 |
| 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 |
$924.10
|
| 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 |
$168.59
|
| 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 |
$186.24
|
| 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 PTA FEM/POP
|
Facility
|
OP
|
$13,017.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
909020065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,603.40 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,603.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,064.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,159.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,762.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,542.58
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Central Health Plan Commercial |
$10,413.60
|
| Rate for Payer: Cigna of CA HMO |
$8,330.88
|
| Rate for Payer: Cigna of CA PPO |
$9,632.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,064.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,064.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,064.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,111.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,206.80
|
| Rate for Payer: Galaxy Health WC |
$11,064.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,810.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,715.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,265.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,725.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,680.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,603.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,111.90
|
| Rate for Payer: Multiplan Commercial |
$9,762.75
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$8,461.05
|
| Rate for Payer: Preferred Health Network WC |
$11,778.14
|
| Rate for Payer: Prime Health Services Commercial |
$11,064.45
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Riverside University Health System MISP |
$5,206.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,810.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,508.50
|
| 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 |
$11,064.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,064.45
|
| Rate for Payer: Vantage Medical Group Senior |
$11,064.45
|
|
|
HC PTA FEM/POP
|
Facility
|
IP
|
$13,017.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
909020065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,603.40 |
| Max. Negotiated Rate |
$11,715.30 |
| Rate for Payer: Adventist Health Commercial |
$2,603.40
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Central Health Plan Commercial |
$10,413.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,111.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,206.80
|
| Rate for Payer: Galaxy Health WC |
$11,064.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,810.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,715.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,265.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,680.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,603.40
|
| Rate for Payer: Multiplan Commercial |
$9,762.75
|
| Rate for Payer: Networks By Design Commercial |
$8,461.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,064.45
|
|
|
HC PTA ILIAC
|
Facility
|
IP
|
$13,017.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,603.40 |
| Max. Negotiated Rate |
$11,715.30 |
| Rate for Payer: Adventist Health Commercial |
$2,603.40
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Central Health Plan Commercial |
$10,413.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,111.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,206.80
|
| Rate for Payer: Galaxy Health WC |
$11,064.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,810.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,715.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,265.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,680.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,603.40
|
| Rate for Payer: Multiplan Commercial |
$9,762.75
|
| Rate for Payer: Networks By Design Commercial |
$8,461.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,064.45
|
|
|
HC PTA ILIAC
|
Facility
|
OP
|
$13,017.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,603.40 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,603.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,064.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,159.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,762.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,542.58
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Central Health Plan Commercial |
$10,413.60
|
| Rate for Payer: Cigna of CA HMO |
$8,330.88
|
| Rate for Payer: Cigna of CA PPO |
$9,632.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,064.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,064.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,064.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,111.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,206.80
|
| Rate for Payer: Galaxy Health WC |
$11,064.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,810.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,715.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,265.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,725.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,680.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,603.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,111.90
|
| Rate for Payer: Multiplan Commercial |
$9,762.75
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$8,461.05
|
| Rate for Payer: Preferred Health Network WC |
$11,778.14
|
| Rate for Payer: Prime Health Services Commercial |
$11,064.45
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Riverside University Health System MISP |
$5,206.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,810.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,508.50
|
| 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 |
$11,064.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,064.45
|
| Rate for Payer: Vantage Medical Group Senior |
$11,064.45
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
IP
|
$12,366.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,473.20 |
| Max. Negotiated Rate |
$11,129.40 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,892.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.40
|
| Rate for Payer: Galaxy Health WC |
$10,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,129.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,852.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,295.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.20
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: Networks By Design Commercial |
$8,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,511.10
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
OP
|
$12,366.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,473.20 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,801.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,274.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,892.80
|
| Rate for Payer: Cigna of CA HMO |
$7,914.24
|
| Rate for Payer: Cigna of CA PPO |
$9,150.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,511.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,511.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.40
|
| Rate for Payer: Galaxy Health WC |
$10,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,129.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,852.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,488.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,295.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,656.20
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: Networks By Design Commercial |
$8,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,511.10
|
| Rate for Payer: Riverside University Health System MISP |
$4,946.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,419.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,183.00
|
| 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 |
$10,511.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,511.10
|
| Rate for Payer: Vantage Medical Group Senior |
$10,511.10
|
|
|
HC PTA INTRACRAN VASO EA ADD DIFF
|
Facility
|
IP
|
$10,933.00
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
909081017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,186.60 |
| Max. Negotiated Rate |
$9,839.70 |
| Rate for Payer: Adventist Health Commercial |
$2,186.60
|
| Rate for Payer: Cash Price |
$4,919.85
|
| Rate for Payer: Central Health Plan Commercial |
$8,746.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,653.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,373.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,373.20
|
| Rate for Payer: Galaxy Health WC |
$9,293.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,559.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,839.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,942.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,450.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,186.60
|
| Rate for Payer: Multiplan Commercial |
$8,199.75
|
| Rate for Payer: Networks By Design Commercial |
$7,106.45
|
| Rate for Payer: Prime Health Services Commercial |
$9,293.05
|
|
|
HC PTA INTRACRAN VASO EA ADD DIFF
|
Facility
|
OP
|
$10,933.00
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
909081017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,186.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,186.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,293.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,013.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,199.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| 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 |
$4,919.85
|
| Rate for Payer: Cash Price |
$4,919.85
|
| Rate for Payer: Central Health Plan Commercial |
$8,746.40
|
| Rate for Payer: Cigna of CA HMO |
$6,997.12
|
| Rate for Payer: Cigna of CA PPO |
$8,090.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,293.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,293.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,293.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,653.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,373.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,373.20
|
| Rate for Payer: Galaxy Health WC |
$9,293.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,559.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,839.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,942.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,450.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,186.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,653.10
|
| Rate for Payer: Multiplan Commercial |
$8,199.75
|
| Rate for Payer: Networks By Design Commercial |
$7,106.45
|
| Rate for Payer: Prime Health Services Commercial |
$9,293.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,373.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,559.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,466.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,293.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,293.05
|
| Rate for Payer: Vantage Medical Group Senior |
$9,293.05
|
|
|
HC PTA INTRACRAN VASOPAMS EA ADDL
|
Facility
|
IP
|
$12,259.00
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
909081016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,451.80 |
| Max. Negotiated Rate |
$11,033.10 |
| Rate for Payer: Adventist Health Commercial |
$2,451.80
|
| Rate for Payer: Cash Price |
$5,516.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,807.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,581.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,903.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,903.60
|
| Rate for Payer: Galaxy Health WC |
$10,420.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,355.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,033.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,784.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,232.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,451.80
|
| Rate for Payer: Multiplan Commercial |
$9,194.25
|
| Rate for Payer: Networks By Design Commercial |
$7,968.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,420.15
|
|
|
HC PTA INTRACRAN VASOPAMS EA ADDL
|
Facility
|
OP
|
$12,259.00
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
909081016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,374.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,451.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,420.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,742.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,194.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| 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 |
$5,516.55
|
| Rate for Payer: Cash Price |
$5,516.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,807.20
|
| Rate for Payer: Cigna of CA HMO |
$7,845.76
|
| Rate for Payer: Cigna of CA PPO |
$9,071.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,420.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,420.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,420.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,581.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,903.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,903.60
|
| Rate for Payer: Galaxy Health WC |
$10,420.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,355.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,033.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,784.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,232.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,451.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,581.30
|
| Rate for Payer: Multiplan Commercial |
$9,194.25
|
| Rate for Payer: Networks By Design Commercial |
$7,968.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,420.15
|
| Rate for Payer: Riverside University Health System MISP |
$4,903.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,355.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,129.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,420.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,420.15
|
| Rate for Payer: Vantage Medical Group Senior |
$10,420.15
|
|
|
HC PTA INTRACRAN VASOSPASM
|
Facility
|
IP
|
$24,475.00
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
909081015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,895.00 |
| Max. Negotiated Rate |
$22,027.50 |
| Rate for Payer: Adventist Health Commercial |
$4,895.00
|
| Rate for Payer: Cash Price |
$11,013.75
|
| Rate for Payer: Central Health Plan Commercial |
$19,580.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,132.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,790.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,790.00
|
| Rate for Payer: Galaxy Health WC |
$20,803.75
|
| Rate for Payer: Global Benefits Group Commercial |
$14,685.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,027.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,541.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,440.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,895.00
|
| Rate for Payer: Multiplan Commercial |
$18,356.25
|
| Rate for Payer: Networks By Design Commercial |
$15,908.75
|
| Rate for Payer: Prime Health Services Commercial |
$20,803.75
|
|
|
HC PTA INTRACRAN VASOSPASM
|
Facility
|
OP
|
$24,475.00
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
909081015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,374.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,895.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,803.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,461.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,356.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| 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 |
$11,013.75
|
| Rate for Payer: Cash Price |
$11,013.75
|
| Rate for Payer: Central Health Plan Commercial |
$19,580.00
|
| Rate for Payer: Cigna of CA HMO |
$15,664.00
|
| Rate for Payer: Cigna of CA PPO |
$18,111.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,803.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,803.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,803.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,132.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,790.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,790.00
|
| Rate for Payer: Galaxy Health WC |
$20,803.75
|
| Rate for Payer: Global Benefits Group Commercial |
$14,685.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,027.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,541.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,440.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,895.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,132.50
|
| Rate for Payer: Multiplan Commercial |
$18,356.25
|
| Rate for Payer: Networks By Design Commercial |
$15,908.75
|
| Rate for Payer: Prime Health Services Commercial |
$20,803.75
|
| Rate for Payer: Riverside University Health System MISP |
$9,790.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,685.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,237.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,803.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,803.75
|
| Rate for Payer: Vantage Medical Group Senior |
$20,803.75
|
|
|
HC PT APPLICATION HOT/COLD PACKS
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 97010
|
| Hospital Charge Code |
905103104
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
|
|
HC PT APPLICATION HOT/COLD PACKS
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 97010
|
| Hospital Charge Code |
905103104
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$56.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Cigna of CA HMO |
$87.68
|
| Rate for Payer: Cigna of CA PPO |
$101.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Riverside University Health System MISP |
$54.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
