|
HC PT PRELIMINARY EVALUATION
|
Facility
|
IP
|
$471.00
|
|
| Hospital Charge Code |
903200136
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$423.90 |
| Rate for Payer: Adventist Health Commercial |
$94.20
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Central Health Plan Commercial |
$376.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.40
|
| Rate for Payer: EPIC Health Plan Senior |
$188.40
|
| Rate for Payer: Galaxy Health WC |
$400.35
|
| Rate for Payer: Global Benefits Group Commercial |
$282.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$291.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.20
|
| Rate for Payer: Multiplan Commercial |
$353.25
|
| Rate for Payer: Networks By Design Commercial |
$306.15
|
| Rate for Payer: Prime Health Services Commercial |
$400.35
|
|
|
HC PT PRELIMINARY EVALUATION
|
Facility
|
OP
|
$471.00
|
|
| Hospital Charge Code |
903200136
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$179.45 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$193.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$286.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$400.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$353.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Central Health Plan Commercial |
$376.80
|
| Rate for Payer: Cigna of CA HMO |
$301.44
|
| Rate for Payer: Cigna of CA PPO |
$348.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$400.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$400.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.40
|
| Rate for Payer: EPIC Health Plan Senior |
$188.40
|
| Rate for Payer: Galaxy Health WC |
$400.35
|
| Rate for Payer: Global Benefits Group Commercial |
$282.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.90
|
| Rate for Payer: InnovAge PACE Commercial |
$235.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$291.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$329.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$329.70
|
| Rate for Payer: Multiplan Commercial |
$353.25
|
| Rate for Payer: Networks By Design Commercial |
$306.15
|
| Rate for Payer: Prime Health Services Commercial |
$400.35
|
| Rate for Payer: Riverside University Health System MISP |
$188.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$400.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.35
|
| Rate for Payer: Vantage Medical Group Senior |
$400.35
|
|
|
HC PT RE-EVALUATION
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
|
|
HC PT RE-EVALUATION
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$256.00
|
| Rate for Payer: Cigna of CA PPO |
$296.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$161.92
|
| Rate for Payer: InnovAge PACE Commercial |
$200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Riverside University Health System MISP |
$160.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC PT RE-EVALUATION COMM MCARE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900419008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
|
|
HC PT RE-EVALUATION COMM MCARE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900419008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$256.00
|
| Rate for Payer: Cigna of CA PPO |
$296.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$161.92
|
| Rate for Payer: InnovAge PACE Commercial |
$200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Riverside University Health System MISP |
$160.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN
|
Facility
|
IP
|
$195.00
|
|
| Hospital Charge Code |
905103300
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN
|
Facility
|
OP
|
$195.00
|
|
| Hospital Charge Code |
905103300
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.30 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$79.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: Cigna of CA HMO |
$124.80
|
| Rate for Payer: Cigna of CA PPO |
$144.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: InnovAge PACE Commercial |
$97.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
| Rate for Payer: Riverside University Health System MISP |
$78.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.75
|
| Rate for Payer: Vantage Medical Group Senior |
$165.75
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN MCAL
|
Facility
|
OP
|
$195.00
|
|
| Hospital Charge Code |
900419011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.30 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$79.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: Cigna of CA HMO |
$124.80
|
| Rate for Payer: Cigna of CA PPO |
$144.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: InnovAge PACE Commercial |
$97.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
| Rate for Payer: Riverside University Health System MISP |
$78.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.75
|
| Rate for Payer: Vantage Medical Group Senior |
$165.75
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN MCAL
|
Facility
|
IP
|
$195.00
|
|
| Hospital Charge Code |
900419011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
|
|
HC PT SINGLE MOD ONE AREA EA ADDL 15 MIN
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
905103301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.62 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$42.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: InnovAge PACE Commercial |
$52.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Riverside University Health System MISP |
$41.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.40
|
| Rate for Payer: Vantage Medical Group Senior |
$88.40
|
|
|
HC PT SINGLE MOD ONE AREA EA ADDL 15 MIN
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
905103301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC PT SINGLE MOD ONE AREA EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
900419012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.62 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$42.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: InnovAge PACE Commercial |
$52.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Riverside University Health System MISP |
$41.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.40
|
| Rate for Payer: Vantage Medical Group Senior |
$88.40
|
|
|
HC PT SINGLE MOD ONE AREA EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
900419012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC PT SINGLE PROC EA ADDL 15 MIN
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
905103303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.62 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$42.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: InnovAge PACE Commercial |
$52.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Riverside University Health System MISP |
$41.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.40
|
| Rate for Payer: Vantage Medical Group Senior |
$88.40
|
|
|
HC PT SINGLE PROC EA ADDL 15 MIN
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
905103303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC PT SINGLE PROC EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
900419021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC PT SINGLE PROC EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
900419021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.62 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$42.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: InnovAge PACE Commercial |
$52.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Riverside University Health System MISP |
$41.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.40
|
| Rate for Payer: Vantage Medical Group Senior |
$88.40
|
|
|
HC PT SINGLE PROC INITIAL 30 MIN
|
Facility
|
IP
|
$195.00
|
|
| Hospital Charge Code |
905103302
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
|
|
HC PT SINGLE PROC INITIAL 30 MIN
|
Facility
|
OP
|
$195.00
|
|
| Hospital Charge Code |
905103302
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.30 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$79.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: Cigna of CA HMO |
$124.80
|
| Rate for Payer: Cigna of CA PPO |
$144.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: InnovAge PACE Commercial |
$97.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
| Rate for Payer: Riverside University Health System MISP |
$78.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.75
|
| Rate for Payer: Vantage Medical Group Senior |
$165.75
|
|
|
HC PT SINGLE PROC INITIAL 30 MIN MCAL
|
Facility
|
IP
|
$195.00
|
|
| Hospital Charge Code |
900419020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
|
|
HC PT SINGLE PROC INITIAL 30 MIN MCAL
|
Facility
|
OP
|
$195.00
|
|
| Hospital Charge Code |
900419020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.30 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$79.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: Cigna of CA HMO |
$124.80
|
| Rate for Payer: Cigna of CA PPO |
$144.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: InnovAge PACE Commercial |
$97.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
| Rate for Payer: Riverside University Health System MISP |
$78.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.75
|
| Rate for Payer: Vantage Medical Group Senior |
$165.75
|
|
|
HC PT SUBSTITUTION
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
900910105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.81
|
| Rate for Payer: Blue Shield of California Commercial |
$25.49
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.32
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.94
|
| Rate for Payer: InnovAge PACE Commercial |
$5.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.94
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Medicare |
$4.18
|
| Rate for Payer: Riverside University Health System MISP |
$4.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Vantage Medical Group Senior |
$3.94
|
|
|
HC PT SUBSTITUTION
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
900910105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Central Health Plan Commercial |
$141.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.40
|
| Rate for Payer: Multiplan Commercial |
$132.75
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
|
|
HC PTT
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.87
|
| Rate for Payer: Blue Shield of California Commercial |
$37.63
|
| Rate for Payer: Blue Shield of California EPN |
$24.61
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Central Health Plan Commercial |
$49.60
|
| Rate for Payer: Cigna of CA HMO |
$39.68
|
| Rate for Payer: Cigna of CA PPO |
$45.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Senior |
$6.01
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: InnovAge PACE Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.01
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Prime Health Services Medicare |
$6.37
|
| Rate for Payer: Riverside University Health System MISP |
$6.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
