|
HC PHP WISDOM GROUP
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804373
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$186.32
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
|
|
HC PHP WISDOM GROUP
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804373
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.78
|
| Rate for Payer: Blue Shield of California Commercial |
$183.91
|
| Rate for Payer: Blue Shield of California EPN |
$120.10
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: Cigna of CA HMO |
$192.64
|
| Rate for Payer: Cigna of CA PPO |
$222.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$150.50
|
| Rate for Payer: United Healthcare HMO Rider |
$150.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC PHP YOUTH-COGNITIVE THERAPY
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804301
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.65
|
| Rate for Payer: Blue Shield of California Commercial |
$228.51
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.00
|
| Rate for Payer: United Healthcare All Other HMO |
$187.00
|
| Rate for Payer: United Healthcare HMO Rider |
$187.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC PHP YOUTH-COGNITIVE THERAPY
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804301
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.51
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC PHP YOUTH COPING RECOVERY
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804300
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.65
|
| Rate for Payer: Blue Shield of California Commercial |
$228.51
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.00
|
| Rate for Payer: United Healthcare All Other HMO |
$187.00
|
| Rate for Payer: United Healthcare HMO Rider |
$187.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC PHP YOUTH COPING RECOVERY
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804300
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.51
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC PHP YOUTH FAMILY THERAPY
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
907804316
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.45
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
|
|
HC PHP YOUTH FAMILY THERAPY
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
907804316
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$87.72 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$204.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$321.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$256.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.68
|
| Rate for Payer: Blue Shield of California Commercial |
$323.22
|
| Rate for Payer: Blue Shield of California EPN |
$211.07
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: Cigna of CA HMO |
$338.56
|
| Rate for Payer: Cigna of CA PPO |
$391.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Senior |
$204.15
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.15
|
| Rate for Payer: InnovAge PACE Commercial |
$306.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.56
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$204.15
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: Prime Health Services Medicare |
$216.40
|
| Rate for Payer: Riverside University Health System MISP |
$224.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.50
|
| Rate for Payer: United Healthcare All Other HMO |
$264.50
|
| Rate for Payer: United Healthcare HMO Rider |
$264.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$204.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Vantage Medical Group Senior |
$204.15
|
|
|
HC PHP YOUTH HEALTH EDUCATION
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804307
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.65
|
| Rate for Payer: Blue Shield of California Commercial |
$228.51
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.00
|
| Rate for Payer: United Healthcare All Other HMO |
$187.00
|
| Rate for Payer: United Healthcare HMO Rider |
$187.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC PHP YOUTH HEALTH EDUCATION
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804307
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.51
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC PHP YOUTH INDIVIDUAL BRIEF
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804317
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.18
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
|
|
HC PHP YOUTH INDIVIDUAL BRIEF
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804317
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$334.81 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$204.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.87
|
| Rate for Payer: Blue Shield of California Commercial |
$160.08
|
| Rate for Payer: Blue Shield of California EPN |
$104.54
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: Cigna of CA HMO |
$167.68
|
| Rate for Payer: Cigna of CA PPO |
$193.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Senior |
$204.15
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.15
|
| Rate for Payer: InnovAge PACE Commercial |
$306.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.56
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$204.15
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
| Rate for Payer: Prime Health Services Medicare |
$216.40
|
| Rate for Payer: Riverside University Health System MISP |
$224.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.00
|
| Rate for Payer: United Healthcare All Other HMO |
$131.00
|
| Rate for Payer: United Healthcare HMO Rider |
$131.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$204.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Vantage Medical Group Senior |
$204.15
|
|
|
HC PHP YOUTH INDIVIDUAL FULL
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804318
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Central Health Plan Commercial |
$358.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Senior |
$179.20
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$403.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.31
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$291.20
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
|
|
HC PHP YOUTH INDIVIDUAL FULL
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804318
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$204.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$272.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$216.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.11
|
| Rate for Payer: Blue Shield of California Commercial |
$273.73
|
| Rate for Payer: Blue Shield of California EPN |
$178.75
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Central Health Plan Commercial |
$358.40
|
| Rate for Payer: Cigna of CA HMO |
$286.72
|
| Rate for Payer: Cigna of CA PPO |
$331.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Senior |
$204.15
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$403.20
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.15
|
| Rate for Payer: InnovAge PACE Commercial |
$306.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.56
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$291.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$204.15
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
| Rate for Payer: Prime Health Services Medicare |
$216.40
|
| Rate for Payer: Riverside University Health System MISP |
$224.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$224.00
|
| Rate for Payer: United Healthcare All Other HMO |
$224.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$204.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Vantage Medical Group Senior |
$204.15
|
|
|
HC PHP YOUTH IOP COGNITIVE THERAPY
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804341
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.18
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
|
|
HC PHP YOUTH IOP COGNITIVE THERAPY
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804341
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.87
|
| Rate for Payer: Blue Shield of California Commercial |
$160.08
|
| Rate for Payer: Blue Shield of California EPN |
$104.54
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: Cigna of CA HMO |
$167.68
|
| Rate for Payer: Cigna of CA PPO |
$193.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.00
|
| Rate for Payer: United Healthcare All Other HMO |
$131.00
|
| Rate for Payer: United Healthcare HMO Rider |
$131.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC PHP YOUTH IOP COPING RECOVERY
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804340
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.65
|
| Rate for Payer: Blue Shield of California Commercial |
$228.51
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.00
|
| Rate for Payer: United Healthcare All Other HMO |
$187.00
|
| Rate for Payer: United Healthcare HMO Rider |
$187.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC PHP YOUTH IOP COPING RECOVERY
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804340
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.51
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC PHP YOUTH IOP FAMILY THERAPY
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
907804356
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.45
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
|
|
HC PHP YOUTH IOP FAMILY THERAPY
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
907804356
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$87.72 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$204.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$321.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$256.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.68
|
| Rate for Payer: Blue Shield of California Commercial |
$323.22
|
| Rate for Payer: Blue Shield of California EPN |
$211.07
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: Cigna of CA HMO |
$338.56
|
| Rate for Payer: Cigna of CA PPO |
$391.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Senior |
$204.15
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.15
|
| Rate for Payer: InnovAge PACE Commercial |
$306.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.56
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$204.15
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: Prime Health Services Medicare |
$216.40
|
| Rate for Payer: Riverside University Health System MISP |
$224.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.50
|
| Rate for Payer: United Healthcare All Other HMO |
$264.50
|
| Rate for Payer: United Healthcare HMO Rider |
$264.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$204.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Vantage Medical Group Senior |
$204.15
|
|
|
HC PHP YOUTH IOP HEALTH EDUCATION
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804347
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$107.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.87
|
| Rate for Payer: Blue Shield of California Commercial |
$160.08
|
| Rate for Payer: Blue Shield of California EPN |
$104.54
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: Cigna of CA HMO |
$167.68
|
| Rate for Payer: Cigna of CA PPO |
$193.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC PHP YOUTH IOP HEALTH EDUCATION
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804347
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.40
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
|
|
HC PHP YOUTH IOP INDIVIDUAL BRIEF
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804357
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$204.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.65
|
| Rate for Payer: Blue Shield of California Commercial |
$228.51
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Senior |
$204.15
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.15
|
| Rate for Payer: InnovAge PACE Commercial |
$306.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.56
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$204.15
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$216.40
|
| Rate for Payer: Riverside University Health System MISP |
$224.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.00
|
| Rate for Payer: United Healthcare All Other HMO |
$187.00
|
| Rate for Payer: United Healthcare HMO Rider |
$187.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$204.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Vantage Medical Group Senior |
$204.15
|
|
|
HC PHP YOUTH IOP INDIVIDUAL BRIEF
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804357
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.51
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC PHP YOUTH IOP INDIVIDUAL FULL
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
907804358
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Central Health Plan Commercial |
$358.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Senior |
$179.20
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$403.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.31
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$291.20
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
|
