|
HC PSEUDOANEURYSM INJECT TRT
|
Facility
|
OP
|
$1,031.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$206.20 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$206.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$785.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$463.95
|
| Rate for Payer: Cash Price |
$463.95
|
| Rate for Payer: Cash Price |
$463.95
|
| Rate for Payer: Central Health Plan Commercial |
$824.80
|
| Rate for Payer: Cigna of CA HMO |
$659.84
|
| Rate for Payer: Cigna of CA PPO |
$762.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$876.35
|
| Rate for Payer: Global Benefits Group Commercial |
$618.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$927.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$268.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: InnovAge PACE Commercial |
$1,178.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$687.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,052.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$773.25
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$670.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$785.56
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$876.35
|
| Rate for Payer: Prime Health Services Medicare |
$832.69
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$864.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$618.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC PSTNR, NEONATAL Z-FLO 10X7
|
Facility
|
IP
|
$135.58
|
|
| Hospital Charge Code |
901605904
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$122.02 |
| Rate for Payer: Adventist Health Commercial |
$27.12
|
| Rate for Payer: Cash Price |
$61.01
|
| Rate for Payer: Central Health Plan Commercial |
$108.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.23
|
| Rate for Payer: EPIC Health Plan Senior |
$54.23
|
| Rate for Payer: Galaxy Health WC |
$115.24
|
| Rate for Payer: Global Benefits Group Commercial |
$81.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Multiplan Commercial |
$101.69
|
| Rate for Payer: Networks By Design Commercial |
$88.13
|
| Rate for Payer: Prime Health Services Commercial |
$115.24
|
|
|
HC PSTNR, NEONATAL Z-FLO 10X7
|
Facility
|
OP
|
$135.58
|
|
| Hospital Charge Code |
901605904
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$122.02 |
| Rate for Payer: Adventist Health Commercial |
$27.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$115.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.63
|
| Rate for Payer: Blue Shield of California Commercial |
$82.84
|
| Rate for Payer: Blue Shield of California EPN |
$54.10
|
| Rate for Payer: Cash Price |
$61.01
|
| Rate for Payer: Central Health Plan Commercial |
$108.46
|
| Rate for Payer: Cigna of CA HMO |
$86.77
|
| Rate for Payer: Cigna of CA PPO |
$100.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$115.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$115.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$115.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.23
|
| Rate for Payer: EPIC Health Plan Senior |
$54.23
|
| Rate for Payer: Galaxy Health WC |
$115.24
|
| Rate for Payer: Global Benefits Group Commercial |
$81.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.02
|
| Rate for Payer: InnovAge PACE Commercial |
$67.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.91
|
| Rate for Payer: Multiplan Commercial |
$101.69
|
| Rate for Payer: Networks By Design Commercial |
$88.13
|
| Rate for Payer: Prime Health Services Commercial |
$115.24
|
| Rate for Payer: Riverside University Health System MISP |
$54.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.79
|
| Rate for Payer: United Healthcare All Other HMO |
$67.79
|
| Rate for Payer: United Healthcare HMO Rider |
$67.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$115.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.24
|
| Rate for Payer: Vantage Medical Group Senior |
$115.24
|
|
|
HC PSTNR, NEONATAL Z-FLO 16X24
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901605556
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC PSTNR, NEONATAL Z-FLO 16X24
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901605556
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC PSTNR, ZFLO NEO 12X20 PICK1300
|
Facility
|
OP
|
$497.87
|
|
| Hospital Charge Code |
901605552
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.57 |
| Max. Negotiated Rate |
$448.08 |
| Rate for Payer: Adventist Health Commercial |
$99.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$302.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$423.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$373.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$241.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.40
|
| Rate for Payer: Blue Shield of California Commercial |
$304.20
|
| Rate for Payer: Blue Shield of California EPN |
$198.65
|
| Rate for Payer: Cash Price |
$224.04
|
| Rate for Payer: Central Health Plan Commercial |
$398.30
|
| Rate for Payer: Cigna of CA HMO |
$318.64
|
| Rate for Payer: Cigna of CA PPO |
$368.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$423.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$423.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$423.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$199.15
|
| Rate for Payer: Galaxy Health WC |
$423.19
|
| Rate for Payer: Global Benefits Group Commercial |
$298.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$448.08
|
| Rate for Payer: InnovAge PACE Commercial |
$248.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$348.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$348.51
|
| Rate for Payer: Multiplan Commercial |
$373.40
|
| Rate for Payer: Networks By Design Commercial |
$323.62
|
| Rate for Payer: Prime Health Services Commercial |
$423.19
|
| Rate for Payer: Riverside University Health System MISP |
$199.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$298.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$298.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.94
|
| Rate for Payer: United Healthcare All Other HMO |
$248.94
|
| Rate for Payer: United Healthcare HMO Rider |
$248.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$423.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$423.19
|
| Rate for Payer: Vantage Medical Group Senior |
$423.19
|
|
|
HC PSTNR, ZFLO NEO 12X20 PICK1300
|
Facility
|
IP
|
$497.87
|
|
| Hospital Charge Code |
901605552
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.57 |
| Max. Negotiated Rate |
$448.08 |
| Rate for Payer: Adventist Health Commercial |
$99.57
|
| Rate for Payer: Cash Price |
$224.04
|
| Rate for Payer: Central Health Plan Commercial |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$199.15
|
| Rate for Payer: Galaxy Health WC |
$423.19
|
| Rate for Payer: Global Benefits Group Commercial |
$298.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$448.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.57
|
| Rate for Payer: Multiplan Commercial |
$373.40
|
| Rate for Payer: Networks By Design Commercial |
$323.62
|
| Rate for Payer: Prime Health Services Commercial |
$423.19
|
|
|
HC PSTNR ZFLO NEO CVR STRAPS 20"
|
Facility
|
OP
|
$19.02
|
|
| Hospital Charge Code |
901698808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$17.12 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.17
|
| Rate for Payer: Blue Shield of California Commercial |
$11.62
|
| Rate for Payer: Blue Shield of California EPN |
$7.59
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Central Health Plan Commercial |
$15.22
|
| Rate for Payer: Cigna of CA HMO |
$12.17
|
| Rate for Payer: Cigna of CA PPO |
$14.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.17
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.12
|
| Rate for Payer: InnovAge PACE Commercial |
$9.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.31
|
| Rate for Payer: Multiplan Commercial |
$14.27
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
| Rate for Payer: Riverside University Health System MISP |
$7.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Senior |
$16.17
|
|
|
HC PSTNR ZFLO NEO CVR STRAPS 20"
|
Facility
|
IP
|
$19.02
|
|
| Hospital Charge Code |
901698808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$17.12 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Central Health Plan Commercial |
$15.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.17
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$14.27
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
|
|
HC PSTNR ZFLO NEO LG W/CVR 12X20"
|
Facility
|
IP
|
$376.59
|
|
| Hospital Charge Code |
901698806
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$338.93 |
| Rate for Payer: Adventist Health Commercial |
$75.32
|
| Rate for Payer: Cash Price |
$169.47
|
| Rate for Payer: Central Health Plan Commercial |
$301.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.64
|
| Rate for Payer: EPIC Health Plan Senior |
$150.64
|
| Rate for Payer: Galaxy Health WC |
$320.10
|
| Rate for Payer: Global Benefits Group Commercial |
$225.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$338.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.32
|
| Rate for Payer: Multiplan Commercial |
$282.44
|
| Rate for Payer: Networks By Design Commercial |
$244.78
|
| Rate for Payer: Prime Health Services Commercial |
$320.10
|
|
|
HC PSTNR ZFLO NEO LG W/CVR 12X20"
|
Facility
|
OP
|
$376.59
|
|
| Hospital Charge Code |
901698806
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$338.93 |
| Rate for Payer: Adventist Health Commercial |
$75.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$221.17
|
| Rate for Payer: Blue Shield of California Commercial |
$230.10
|
| Rate for Payer: Blue Shield of California EPN |
$150.26
|
| Rate for Payer: Cash Price |
$169.47
|
| Rate for Payer: Central Health Plan Commercial |
$301.27
|
| Rate for Payer: Cigna of CA HMO |
$241.02
|
| Rate for Payer: Cigna of CA PPO |
$278.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.64
|
| Rate for Payer: EPIC Health Plan Senior |
$150.64
|
| Rate for Payer: Galaxy Health WC |
$320.10
|
| Rate for Payer: Global Benefits Group Commercial |
$225.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$338.93
|
| Rate for Payer: InnovAge PACE Commercial |
$188.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.61
|
| Rate for Payer: Multiplan Commercial |
$282.44
|
| Rate for Payer: Networks By Design Commercial |
$244.78
|
| Rate for Payer: Prime Health Services Commercial |
$320.10
|
| Rate for Payer: Riverside University Health System MISP |
$150.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$225.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.29
|
| Rate for Payer: United Healthcare All Other HMO |
$188.29
|
| Rate for Payer: United Healthcare HMO Rider |
$188.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.10
|
| Rate for Payer: Vantage Medical Group Senior |
$320.10
|
|
|
HC PSTNR ZFLO NEO MED W/CVR 9X15"
|
Facility
|
IP
|
$227.15
|
|
| Hospital Charge Code |
901698807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$204.44 |
| Rate for Payer: Adventist Health Commercial |
$45.43
|
| Rate for Payer: Cash Price |
$102.22
|
| Rate for Payer: Central Health Plan Commercial |
$181.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.86
|
| Rate for Payer: EPIC Health Plan Senior |
$90.86
|
| Rate for Payer: Galaxy Health WC |
$193.08
|
| Rate for Payer: Global Benefits Group Commercial |
$136.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.43
|
| Rate for Payer: Multiplan Commercial |
$170.36
|
| Rate for Payer: Networks By Design Commercial |
$147.65
|
| Rate for Payer: Prime Health Services Commercial |
$193.08
|
|
|
HC PSTNR ZFLO NEO MED W/CVR 9X15"
|
Facility
|
OP
|
$227.15
|
|
| Hospital Charge Code |
901698807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$204.44 |
| Rate for Payer: Adventist Health Commercial |
$45.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$170.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.41
|
| Rate for Payer: Blue Shield of California Commercial |
$138.79
|
| Rate for Payer: Blue Shield of California EPN |
$90.63
|
| Rate for Payer: Cash Price |
$102.22
|
| Rate for Payer: Central Health Plan Commercial |
$181.72
|
| Rate for Payer: Cigna of CA HMO |
$145.38
|
| Rate for Payer: Cigna of CA PPO |
$168.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.86
|
| Rate for Payer: EPIC Health Plan Senior |
$90.86
|
| Rate for Payer: Galaxy Health WC |
$193.08
|
| Rate for Payer: Global Benefits Group Commercial |
$136.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.44
|
| Rate for Payer: InnovAge PACE Commercial |
$113.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$159.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$170.36
|
| Rate for Payer: Networks By Design Commercial |
$147.65
|
| Rate for Payer: Prime Health Services Commercial |
$193.08
|
| Rate for Payer: Riverside University Health System MISP |
$90.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.58
|
| Rate for Payer: United Healthcare All Other HMO |
$113.58
|
| Rate for Payer: United Healthcare HMO Rider |
$113.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$193.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.08
|
| Rate for Payer: Vantage Medical Group Senior |
$193.08
|
|
|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.67
|
| Rate for Payer: Blue Shield of California Commercial |
$295.11
|
| Rate for Payer: Blue Shield of California EPN |
$192.72
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$410.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.85
|
| Rate for Payer: InnovAge PACE Commercial |
$241.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Riverside University Health System MISP |
$193.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.50
|
| Rate for Payer: United Healthcare All Other HMO |
$241.50
|
| Rate for Payer: United Healthcare HMO Rider |
$241.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.67
|
| Rate for Payer: Blue Shield of California Commercial |
$295.11
|
| Rate for Payer: Blue Shield of California EPN |
$192.72
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$410.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.85
|
| Rate for Payer: InnovAge PACE Commercial |
$241.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Riverside University Health System MISP |
$193.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.50
|
| Rate for Payer: United Healthcare All Other HMO |
$241.50
|
| Rate for Payer: United Healthcare HMO Rider |
$241.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
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: 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 Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC PSYCH 30 MIN W PT W EVAL
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
900100703
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: 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 Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC PSYCH 45 MIN W PT W EVAL
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
900100704
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$542.70 |
| Rate for Payer: Adventist Health Commercial |
$120.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$366.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$512.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$452.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$291.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$354.14
|
| Rate for Payer: Blue Shield of California Commercial |
$368.43
|
| Rate for Payer: Blue Shield of California EPN |
$240.60
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Central Health Plan Commercial |
$482.40
|
| Rate for Payer: Cigna of CA HMO |
$385.92
|
| Rate for Payer: Cigna of CA PPO |
$446.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$512.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$512.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$512.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$241.20
|
| Rate for Payer: Galaxy Health WC |
$512.55
|
| Rate for Payer: Global Benefits Group Commercial |
$361.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$542.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.42
|
| Rate for Payer: InnovAge PACE Commercial |
$301.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$402.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$373.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$422.10
|
| Rate for Payer: Multiplan Commercial |
$452.25
|
| Rate for Payer: Networks By Design Commercial |
$391.95
|
| Rate for Payer: Prime Health Services Commercial |
$512.55
|
| Rate for Payer: Riverside University Health System MISP |
$241.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$361.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$361.80
|
| Rate for Payer: 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: Vantage Medical Group Commercial/Exchange |
$512.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$512.55
|
| Rate for Payer: Vantage Medical Group Senior |
$512.55
|
|
|
HC PSYCH 45 MIN W PT W EVAL
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
900100704
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$542.70 |
| Rate for Payer: Adventist Health Commercial |
$120.60
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Central Health Plan Commercial |
$482.40
|
| Rate for Payer: 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 Permanente of CA Commercial/Self Funded |
$402.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$373.26
|
| Rate for Payer: Multiplan Commercial |
$452.25
|
| Rate for Payer: Networks By Design Commercial |
$391.95
|
| Rate for Payer: Prime Health Services Commercial |
$512.55
|
|
|
HC PSYCH 60 MIN W PT W EVAL
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
900100705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$568.80 |
| Rate for Payer: Adventist Health Commercial |
$126.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$383.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$537.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$347.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$474.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$306.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$371.17
|
| Rate for Payer: Blue Shield of California Commercial |
$386.15
|
| Rate for Payer: Blue Shield of California EPN |
$252.17
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Central Health Plan Commercial |
$505.60
|
| Rate for Payer: Cigna of CA HMO |
$404.48
|
| Rate for Payer: Cigna of CA PPO |
$467.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$537.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$537.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$537.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.80
|
| Rate for Payer: EPIC Health Plan Senior |
$252.80
|
| Rate for Payer: Galaxy Health WC |
$537.20
|
| Rate for Payer: Global Benefits Group Commercial |
$379.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$568.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$179.10
|
| Rate for Payer: InnovAge PACE Commercial |
$316.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$421.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$391.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$442.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$442.40
|
| Rate for Payer: Multiplan Commercial |
$474.00
|
| Rate for Payer: Networks By Design Commercial |
$410.80
|
| Rate for Payer: Prime Health Services Commercial |
$537.20
|
| Rate for Payer: Riverside University Health System MISP |
$252.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$379.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$379.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.00
|
| Rate for Payer: United Healthcare All Other HMO |
$316.00
|
| Rate for Payer: United Healthcare HMO Rider |
$316.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$316.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$537.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$537.20
|
| Rate for Payer: Vantage Medical Group Senior |
$537.20
|
|
|
HC PSYCH 60 MIN W PT W EVAL
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
900100705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$568.80 |
| Rate for Payer: Adventist Health Commercial |
$126.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Central Health Plan Commercial |
$505.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.80
|
| Rate for Payer: EPIC Health Plan Senior |
$252.80
|
| Rate for Payer: Galaxy Health WC |
$537.20
|
| Rate for Payer: Global Benefits Group Commercial |
$379.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$568.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$421.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$391.21
|
| Rate for Payer: Multiplan Commercial |
$474.00
|
| Rate for Payer: Networks By Design Commercial |
$410.80
|
| Rate for Payer: Prime Health Services Commercial |
$537.20
|
|
|
HC PSYCH CRISIS EA ADD 30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
900100707
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.13
|
| Rate for Payer: Blue Shield of California Commercial |
$147.86
|
| Rate for Payer: Blue Shield of California EPN |
$96.56
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.43
|
| Rate for Payer: InnovAge PACE Commercial |
$121.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$169.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Riverside University Health System MISP |
$96.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$121.00
|
| Rate for Payer: United Healthcare HMO Rider |
$121.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC PSYCH CRISIS EA ADD 30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
900100707
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.13
|
| Rate for Payer: Blue Shield of California Commercial |
$147.86
|
| Rate for Payer: Blue Shield of California EPN |
$96.56
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.43
|
| Rate for Payer: InnovAge PACE Commercial |
$121.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$169.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Riverside University Health System MISP |
$96.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$121.00
|
| Rate for Payer: United Healthcare HMO Rider |
$121.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC PSYCH CRISIS EA ADD 30 MIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
900100707
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC PSYCH CRISIS EA ADD 30 MIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
900100707
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
