|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna of CA HMO |
$455.68
|
| Rate for Payer: Cigna of CA PPO |
$526.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$569.60
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$462.80
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$356.00
|
| Rate for Payer: United Healthcare All Other HMO |
$356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$356.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC DEST OF LESIONS LT 10 SQ CM
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.60 |
| Max. Negotiated Rate |
$725.05 |
| Rate for Payer: Adventist Health Commercial |
$170.60
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.20
|
| Rate for Payer: EPIC Health Plan Senior |
$341.20
|
| Rate for Payer: Galaxy Health WC |
$725.05
|
| Rate for Payer: Global Benefits Group Commercial |
$511.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.72
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: Networks By Design Commercial |
$554.45
|
| Rate for Payer: Prime Health Services Commercial |
$725.05
|
|
|
HC DEST OF LESIONS LT 10 SQ CM
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$170.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cigna of CA HMO |
$545.92
|
| Rate for Payer: Cigna of CA PPO |
$631.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$725.05
|
| Rate for Payer: Global Benefits Group Commercial |
$511.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$554.45
|
| Rate for Payer: Prime Health Services Commercial |
$725.05
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$511.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$426.50
|
| Rate for Payer: United Healthcare All Other HMO |
$426.50
|
| Rate for Payer: United Healthcare HMO Rider |
$426.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$426.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC DESTROY INTERNAL HEMORRHOIDS
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 46930
|
| Hospital Charge Code |
906746930
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$484.00 |
| Max. Negotiated Rate |
$2,057.00 |
| Rate for Payer: Adventist Health Commercial |
$484.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$968.00
|
| Rate for Payer: EPIC Health Plan Senior |
$968.00
|
| Rate for Payer: Galaxy Health WC |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$922.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,497.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.80
|
| Rate for Payer: Multiplan Commercial |
$1,936.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
|
|
HC DESTROY INTERNAL HEMORRHOIDS
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 46930
|
| Hospital Charge Code |
906746930
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$484.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cigna of CA HMO |
$1,548.80
|
| Rate for Payer: Cigna of CA PPO |
$1,790.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$1,936.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,452.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.77
|
| 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 |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna of CA HMO |
$186.88
|
| Rate for Payer: Cigna of CA PPO |
$216.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$248.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$204.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$204.40
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$146.00
|
| Rate for Payer: United Healthcare All Other HMO |
$146.00
|
| Rate for Payer: United Healthcare HMO Rider |
$146.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
|
|
HC DEVELOPMENT COG SKILLS 15 MIN MCAL
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
901300062
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$99.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$158.73
|
| 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 HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| 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: 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 |
$58.08
|
| 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 |
$193.60
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| 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 |
$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 |
$205.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC DEVELOPMENT COG SKILLS 15 MIN MCAL
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
901300062
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$205.70 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$108.90
|
| 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: 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 |
$58.08
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC DEVELOPMENT COG SKILLS 15 MIN ST MCAL
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
907000011
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$99.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$158.73
|
| 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 HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| 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: 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 |
$58.08
|
| 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 |
$193.60
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| 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 |
$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 |
$205.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC DEVELOPMENT COG SKILLS 15 MIN ST MCAL
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
907000011
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$205.70 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$108.90
|
| 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: 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 |
$58.08
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC DEVELOP TEST EXT W RPT MCAL
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
901300037
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Adventist Health Commercial |
$427.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$683.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$885.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$573.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$781.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cigna of CA HMO |
$666.88
|
| Rate for Payer: Cigna of CA PPO |
$771.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$885.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$885.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$885.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.80
|
| Rate for Payer: EPIC Health Plan Senior |
$416.80
|
| Rate for Payer: Galaxy Health WC |
$885.70
|
| Rate for Payer: Global Benefits Group Commercial |
$625.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$695.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$645.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$729.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$729.40
|
| Rate for Payer: Multiplan Commercial |
$833.60
|
| Rate for Payer: Networks By Design Commercial |
$677.30
|
| Rate for Payer: Prime Health Services Commercial |
$885.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$625.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$625.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$885.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$885.70
|
| Rate for Payer: Vantage Medical Group Senior |
$885.70
|
|
|
HC DEVELOP TEST EXT W RPT MCAL
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
901300037
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$208.40 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Adventist Health Commercial |
$208.40
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.80
|
| Rate for Payer: EPIC Health Plan Senior |
$416.80
|
| Rate for Payer: Galaxy Health WC |
$885.70
|
| Rate for Payer: Global Benefits Group Commercial |
$625.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$695.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$645.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.08
|
| Rate for Payer: Multiplan Commercial |
$833.60
|
| Rate for Payer: Networks By Design Commercial |
$677.30
|
| Rate for Payer: Prime Health Services Commercial |
$885.70
|
|
|
HC DEVELOP TEST EXT W/RPT ST MCAL
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
907000007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Adventist Health Commercial |
$427.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$683.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$885.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$573.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$781.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cigna of CA HMO |
$666.88
|
| Rate for Payer: Cigna of CA PPO |
$771.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$885.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$885.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$885.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.80
|
| Rate for Payer: EPIC Health Plan Senior |
$416.80
|
| Rate for Payer: Galaxy Health WC |
$885.70
|
| Rate for Payer: Global Benefits Group Commercial |
$625.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$695.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$645.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$729.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$729.40
|
| Rate for Payer: Multiplan Commercial |
$833.60
|
| Rate for Payer: Networks By Design Commercial |
$677.30
|
| Rate for Payer: Prime Health Services Commercial |
$885.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$625.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$625.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$885.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$885.70
|
| Rate for Payer: Vantage Medical Group Senior |
$885.70
|
|
|
HC DEVELOP TEST EXT W/RPT ST MCAL
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
907000007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$208.40 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Adventist Health Commercial |
$208.40
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.80
|
| Rate for Payer: EPIC Health Plan Senior |
$416.80
|
| Rate for Payer: Galaxy Health WC |
$885.70
|
| Rate for Payer: Global Benefits Group Commercial |
$625.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$695.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$645.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.08
|
| Rate for Payer: Multiplan Commercial |
$833.60
|
| Rate for Payer: Networks By Design Commercial |
$677.30
|
| Rate for Payer: Prime Health Services Commercial |
$885.70
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Adventist Health Commercial |
$226.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$699.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Adventist Health Commercial |
$226.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$699.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Adventist Health Commercial |
$463.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$741.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$847.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$699.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$791.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$791.00
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| 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 |
$960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Adventist Health Commercial |
$226.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$741.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$847.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$693.93
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$699.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$791.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$791.00
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$565.00
|
| Rate for Payer: United Healthcare All Other HMO |
$565.00
|
| Rate for Payer: United Healthcare HMO Rider |
$565.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$565.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Adventist Health Commercial |
$463.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$741.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$847.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$699.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$791.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$791.00
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| 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 |
$960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Adventist Health Commercial |
$226.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$699.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Adventist Health Commercial |
$226.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$699.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Adventist Health Commercial |
$463.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$741.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$847.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$699.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$791.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$791.00
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| 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 |
$960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
IP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
915356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,676.60 |
| Max. Negotiated Rate |
$32,625.55 |
| Rate for Payer: Adventist Health Commercial |
$7,676.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,601.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,623.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,759.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,211.92
|
| Rate for Payer: Multiplan Commercial |
$30,706.40
|
| Rate for Payer: Networks By Design Commercial |
$19,191.50
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
OP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
905356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,211.92 |
| Max. Negotiated Rate |
$32,625.55 |
| Rate for Payer: Adventist Health Commercial |
$15,737.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,110.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,787.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,231.43
|
| Rate for Payer: Blue Shield of California Commercial |
$28,326.65
|
| Rate for Payer: Blue Shield of California EPN |
$18,654.14
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Cash Price |
$17,272.35
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,625.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,625.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,643.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,601.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,906.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,759.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,211.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,868.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,868.10
|
| Rate for Payer: Multiplan Commercial |
$30,706.40
|
| Rate for Payer: Networks By Design Commercial |
$19,191.50
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,029.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,029.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Senior |
$32,625.55
|
|
